Calcium and vitamin D supplement: right or wrong?

Intuitively, one might think that supplementing vitamins and minerals would be the right thing to do especially in older and comorbid people. Every year, billions of dollars are spent in this belief.1 However, we may all be wrong.

A present study in this journal demonstrates a significantly increased cardiovascular (CV) mortality in elderly patients supplementing calcium, be it with or without vitamin D, who initially presented with mild to moderate aortic stenosis (AS) in a longitudinal analysis of a large contemporary echocardiography database cohort of 2657 patients.2 Patients were followed for aortic valve replacement (AVR) and/or death, as well as AS progression. About half of the study population was on supplementation, with about 40% taking calcium including vitamin D or not during more than 5.5 years. The absolute risk of CV mortality was strikingly higher with 13.7 for calcium±vitamin D supplementation and 9.6 for vitamin D only, compared with 5.8 per 1000 person-years in no supplementation. Surprisingly, also all-cause mortality was significantly higher with calcium addition. In almost half of the patients with calcium administration, AVR was performed during the follow-up, whereas AVR was needed in only 11% of non-supplementers. Interestingly, when stratifying by osteoporosis status, the differences in survival and AVR persisted unaltered between the groups.2

Calcium: the secret key?

Calcification is the cardinal process driving a vicious cycle that propagates aortic valve (AV) stiffness and obstruction.3 Disruption of the endothelial layer promotes the uptake of oxidised lipids and immune cells, promoting an inflammation–calcification loop with fibrotic remodelling of the aortic leaflets.4 Activation of the valvular interstitial cells (VICs) induces their osteogenic osteoblastic differentiation and collagen secretion, …