Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg)
- 1Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
- 2Institute of Epidemiology, Helmholtz Centre Munich, Neuherberg, Germany
- 3Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Switzerland
- Correspondence to Professor Sabine Rohrmann, Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland;
Contributors KL: data analysis, result interpretation and manuscript writing. JL, RK and SR: reviewed and commented on the manuscript. RK: administrative and financial support.
- Accepted 15 February 2012
- Published Online First 23 May 2012
Background It has been suggested that a higher calcium intake might favourably modify cardiovascular risk factors. However, findings of an ultimately decreased risk of cardiovascular disease (CVD) are limited. Instead, recent evidence warns that taking calcium supplements might increase myocardial infarction (MI) risk.
Objective To prospectively evaluate the associations of dietary calcium intake and calcium supplementation with MI and stroke risk and overall CVD mortality.
Methods Data from 23 980 Heidelberg cohort participants of the European Prospective Investigation into Cancer and Nutrition study, aged 35–64 years and free of major CVD events at recruitment, were analysed. Multivariate Cox regression models were used to estimate HRs and 95% CIs.
Results After an average follow-up time of 11 years, 354 MI and 260 stroke cases and 267 CVD deaths were documented. Compared with the lowest quartile, the third quartile of total dietary and dairy calcium intake had a significantly reduced MI risk, with a HR of 0.69 (95% CI 0.50 to 0.94) and 0.68 (95% CI 0.50 to 0.93), respectively. Associations for stroke risk and CVD mortality were overall null. In comparison with non-users of any supplements, users of calcium supplements had a statistically significantly increased MI risk (HR=1.86; 95% CI 1.17 to 2.96), which was more pronounced for calcium supplement only users (HR=2.39; 95% CI 1.12 to 5.12).
Conclusions Increasing calcium intake from diet might not confer significant cardiovascular benefits, while calcium supplements, which might raise MI risk, should be taken with caution.
Linked articles 300806.
Funding This work was supported by supported by the Deutsche Krebshilfe (grant-No 70-488-Ha I) and the Graduiertenkolleg 793: Epidemiology of communicable and chronic non-communicable disease and their inter-relationships.
Competing interests None.
Patient consent Obtained.
Ethics approval Ethics approval was provided by the ethics committee of the Heidelberg University Medical School.
Provenance and peer review Not commissioned; internally peer reviewed.