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Response to: Rapid response by Diehl on 'Supplemental calcium and vitamin D and long-term mortality in aortic stenosis'
  1. Nicholas Kassis1,
  2. Essa Hariri1,
  3. Samir Kapadia2
  1. 1 Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  2. 2 Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  1. Correspondence to Dr Nicholas Kassis, Cleveland Clinic Foundation, Cleveland, Ohio, USA; kassisn{at}

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We appreciate the critical review of our study1 by Dr Diehl ( The concern surrounding our caution towards unrestricted oral calcium supplementation is a reasonable one, certainly when considering the public reception of our claims and the effects that such reactions may have on those who are vulnerable to underlying bone disease. We agree that physicians and patients alike are prone to these impressions. We further acknowledge, as we note in the Limitations section, that the absence of specific dosages in our study serves as a pitfall in identifying any theoretically harmful threshold of supplementation or dose-dependent association with outcomes.

It is for these reasons that we centre our message on the effects …

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  • Contributors NK, EH and SK conceived, designed, drafted and critically revised the correspondence. SK supervised the process. NK, EH and SK are responsible for the overall content and serve as guarantors. All authors read and approved the final correspondence.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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