This meta-analysis show that calcium supplements may increase the risk of heart attack

1. www.pronutritionist.net
Effect of calcium supplements on
risk of myocardial infarction and
cardiovascular events: meta-
analysis.
Bolland MJ et al. BMJ 2010;341:c3691
Page 1 Bolland MJ et al. BMJ 2010;341:c3691

2. Page 2
Background
• Sufficient intake of calcium is essential for bone health
• Calcium and vitamin D are considered as basic treatments in
fracture prevention among both osteopenic and osteoporotic
patients
• Previous observational studies have demonstrated positive
association between high calcium intake and cardiovascular
health
• In some recent studies high calcium intake as supplements has
been linked to increased risk of cardiovascular events in renal
failure
• High intake of calcium is also associated to increased incidence
of prostate cancer
www.pronutritionist.netBolland MJ et al. BMJ 2010;341:c3691

3. Methods
• n=11 921,meta-analysis of randomized placebo controlled
trials. Patients were overwhelmingly female, typically
osteoporotic seniors
• None of the trials included was designed (and powered) for
cardiovascular outcomes (mainly fracture prevention
studies).
• Intervention: minimum 500 mg of calcium daily without
concurrent vitamin D
• Follow up: ≈ 4 years
• End points: MI, stroke, sudden death and their composite
end point
3 www.pronutritionist.netBolland MJ et al. BMJ 2010;341:c3691

4. Results, myocardial infarctions (#)
4 Bolland MJ et al. BMJ 2010;341:c3691 www.pronutritionist.net
+27 %

5. Results, other CV endpoints
• No difference in strokes (1.20, 0.96 to 1.50, P=0.11)
• No difference in deaths (1.09, 0.96 to 1.23, P=0.18)
• No difference in composite end point (1.18, 1.00 to 1.39,
P=0.057)
5 Bolland MJ et al. BMJ 2010;341:c3691 www.pronutritionist.net

6. Discussion
• Results of the meta-analysis are in contrast to
observational studies, and raise concern about the safety
of large scale use of calcium supplementation
• As the included studies were not designed to explore
cardiovascular events, they are subject to bias
• Renal failure is common among elderly females, this
meta-analysis and previous studies in renal failure throw
doubt on the recommendation of routine calcium
supplementation in elderly osteopenia and osteoporosis
• Mechanism behind the phenomenon is unknown,
vascular calcification is suggested
• Authors conclude that reassessment of osteoporosis
guidelines is warranted
6 www.pronutritionist.netBolland MJ et al. BMJ 2010;341:c3691

7. Discussion
• Results of the meta-analysis are in contrast to
observational studies, and raise concern about the safety
of large scale use of calcium supplementation
• As the included studies were not designed to explore
cardiovascular events, they are subject to bias
• Renal failure is common among elderly females, this
meta-analysis and previous studies in renal failure throw
doubt on the recommendation of routine calcium
supplementation in elderly osteopenia and osteoporosis
• Mechanism behind the phenomenon is unknown,
vascular calcification is suggested
• Authors conclude that reassessment of osteoporosis
guidelines is warranted
6 www.pronutritionist.netBolland MJ et al. BMJ 2010;341:c3691