Calcium intake, calcium supplementation and cardiovascular disease and mortality in the British population: EPIC-norfolk prospective cohort study and meta-analysis
Open Access
- 30 December 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Journal of Epidemiology
- Vol. 36 (7), 669-683
- https://doi.org/10.1007/s10654-020-00710-8
Abstract
The role of dietary calcium in cardiovascular disease prevention is unclear. We aimed to determine the association between calcium intake and incident cardiovascular disease and mortality. Data were extracted from the European Prospective Investigation of Cancer, Norfolk (EPIC-Norfolk). Multivariable Cox regressions analysed associations between calcium intake (dietary and supplemental) and cardiovascular disease (myocardial infarction, stroke, heart failure, aortic stenosis, peripheral vascular disease) and mortality (cardiovascular and all-cause). The results of this study were pooled with those from published prospective cohort studies in a meta-analsyis, stratifying by average calcium intake using a 700 mg/day threshold. A total of 17,968 participants aged 40–79 years were followed up for a median of 20.36 years (20.32–20.38). Compared to the first quintile of calcium intake (< 770 mg/day), intakes between 771 and 926 mg/day (second quintile) and 1074–1254 mg/day (fourth quintile) were associated with reduced all-cause mortality (HR 0.91 (0.83–0.99) and 0.85 (0.77–0.93), respectively) and cardiovascular mortality [HR 0.95 (0.87–1.04) and 0.93 (0.83-1.04)]. Compared to the first quintile of calcium intake, second, third, fourth, but not fifth quintiles were associated with fewer incident strokes: respective HR 0.84 (0.72–0.97), 0.83 (0.71–0.97), 0.78 (0.66–0.92) and 0.95 (0.78–1.15). The meta-analysis results suggest that high levels of calcium intake were associated with decreased all-cause mortality, but not cardiovascular mortality, regardless of average calcium intake. Calcium supplementation was associated with cardiovascular and all-cause mortality amongst women, but not men. Moderate dietary calcium intake may protect against cardiovascular and all-cause mortality and incident stroke. Calcium supplementation may reduce mortality in women.Funding Information
- Medical Research Council (MR/N003284/1, MC-UU_12015/1)
- Cancer Research UK (C864/A14136)
This publication has 48 references indexed in Scilit:
- A Prospective Cohort Study Examining the Associations of Dietary Calcium Intake with All-Cause and Cardiovascular Mortality in Older Chinese Community-Dwelling PeoplePLOS ONE, 2013
- Calcium Intake and Serum Concentration in Relation to Risk of Cardiovascular Death in NHANES IIIPLOS ONE, 2013
- Modifying effect of calcium/magnesium intake ratio and mortality: a population-based cohort studyBMJ Open, 2013
- Health risks and benefits from calcium and vitamin D supplementation: Women's Health Initiative clinical trial and cohort studyOsteoporosis International, 2012
- Dietary Calcium and Magnesium Intake and Mortality: A Prospective Study of MenAmerican Journal of Epidemiology, 2010
- Accuracy of death certification and hospital record linkage for identification of incident strokeBMC Medical Research Methodology, 2008
- Dietary Calcium Intake and Risks of Stroke, Its Subtypes, and Coronary Heart Disease in JapaneseStroke, 2008
- Hard drinking water does not protect against cardiovascular disease: new evidence from the British Regional Heart StudyEuropean Journal of Preventive Cardiology, 2008
- Carotid artery plaque thickness is associated with increased serum calcium levels: The Northern Manhattan studyAtherosclerosis, 2007
- Residential area deprivation predicts smoking habit independently of individual educational level and occupational social class. A cross sectional study in the Norfolk cohort of the European Investigation into Cancer (EPIC-Norfolk)Journal of Epidemiology and Community Health, 2003