Dietary calcium intake and mortality risk from cardiovascular disease and all causes: a meta-analysis of prospective cohort studies

BMC Medicine

Maosheng Yan³  Wei Bao²  Gang Zhao⁴  Jun Liu²  Yingying Ouyang²  Hongxia Chen¹  Xia Wang² 

[1] Institute of Biomedicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China;Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430030, China;Guangdong Provincial Key Laboratory of Occupational Disease Prevention and Treatment, Guangdong Provincial Hospital for Occupational Disease Prevention and Treatment, 68 Haikang Road, Guangzhou 510300, China;Department of Cardiovascular Sciences, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China

关键词: Mortality;    Meta-analysis;    Cohort;    Cardiovascular disease;    Calcium;   

Others  :  1121428
DOI  :  10.1186/s12916-014-0158-6

 received in 2014-04-22, accepted in 2014-08-20,  发布年份 2014

【 摘 要 】

Background

Considerable controversy exists regarding the association between dietary calcium intake and risk of mortality from cardiovascular disease and all causes. Therefore, we performed a meta-analysis of prospective cohort studies to examine the controversy.

Methods

We identified relevant studies by searching MEDLINE, Embase, and the Cochrane Library databases between 1 September 2013 and 30 December 2013. Reference lists of relevant articles were also reviewed. Observational prospective studies that reported relative risks and 95% confidence intervals for the association of calcium intake with cardiovascular and all-cause mortality were eligible. Study-specific relative risks were pooled using a random-effects model.

Results

In this meta-analysis, 11 prospective studies with 12 independent cohorts, involving 757,304 participants, were eligible. There was evidence of a non-linear association between dietary calcium intake and risk of mortality from cardiovascular disease (P for non-linearity <0.01) and all causes (P for non-linearity <0.01). A dose-response analysis showed a U-shaped relationship between dietary calcium intake and cardiovascular mortality. Intakes that were lower and higher than around 800 mg/day were gradually associated with a higher risk of cardiovascular mortality. For all-cause mortality, we also observed a threshold effect at intakes around 900 mg/day. The risk of all-cause mortality did not decrease further at intakes above 900 mg/day.

Conclusions

This meta-analysis of prospective cohort studies suggests that dietary calcium intake is associated with cardiovascular mortality in a U-shaped manner and that high dietary calcium intake (>900 mg/day) is not associated with a decreased risk of all-cause mortality.

【 授权许可】

   
2014 Wang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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【 参考文献 】

• [1]Ross AC, Taylor CL, Yaktine AL, del Valle HB: Dietary Reference Intakes for Calcium and Vitamin D. National Academies Press; 2010.
• [2]Mangano KM, Walsh SJ, Insogna KL, Kenny AM, Kerstetter JE: Calcium intake in the United States from dietary and supplemental sources across adult age groups: new estimates from the National Health and Nutrition Examination Survey 2003–2006. J Am Diet Assoc 2011, 111:687-695.
• [3]Bailey RL, Dodd KW, Goldman JA, Gahche JJ, Dwyer JT, Moshfegh AJ, Sempos CT, Picciano MF: Estimation of total usual calcium and vitamin D intakes in the United States. J Nutr 2010, 140:817-822.
• [4]Bostick RM, Kushi LH, Wu Y, Meyer KA, Sellers TA, Folsom AR: Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol 1999, 149:151-161.
• [5]Kaluza J, Orsini N, Levitan EB, Brzozowska A, Roszkowski W, Wolk A: Dietary calcium and magnesium intake and mortality: a prospective study of men. Am J Epidemiol 2010, 171:801-807.
• [6]Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, Reid IR: Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010, 341:c3691.
• [7]Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, Gamble GD, Grey A, Reid IR: Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ 2008, 336:262-266.
• [8]Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR: Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ 2011, 342:d2040.
• [9]Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB: Meta-analysis of observational studies in epidemiology. JAMA 2000, 283:2008-2012.
• [10][http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp] webcite Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P: The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. 2000, [].
• [11]Hedges LV, Olkin I, Statistiker M: Statistical Methods for Meta-Analysis. Academic Press, Orlando, FL; 1985.
• [12]Higgins J, Thompson SG, Deeks JJ, Altman DG: Measuring inconsistency in meta-analyses. BMJ 2003, 327:557-560.
• [13]Greenland S, Longnecker MP: Methods for trend estimation from summarized dose–response data, with applications to meta-analysis. Am J Epidemiol 1992, 135:1301-1309.
• [14]Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D: Meta-analysis for linear and nonlinear dose–response relations: examples, an evaluation of approximations, and software. Am J Epidemiol 2012, 175:66-73.
• [15]Berlin JA, Longnecker MP, Greenland S: Meta-analysis of epidemiologic dose–response data. Epidemiology 1993, 4:218-228.
• [16]Jackson D, White IR, Thompson SG: Extending DerSimonian and Laird’s methodology to perform multivariate random effects meta‐analyses. Stat Med 2010, 29:1282-1297.
• [17]Larsson SC, Orsini N: Coffee consumption and risk of stroke: a dose–response meta-analysis of prospective studies. Am J Epidemiol 2011, 174:993-1001.
• [18]Umesawa M, Iso H, Ishihara J, Saito I, Kokubo Y, Inoue M, Tsugane S: Dietary calcium intake and risks of stroke, its subtypes, and coronary heart disease in Japanese: the JPHC Study Cohort I. Stroke 2008, 39:2449-2456.
• [19]Marniemi J, Alanen E, Impivaara O, Seppänen R, Hakala P, Rajala T, Rönnemaa T: Dietary and serum vitamins and minerals as predictors of myocardial infarction and stroke in elderly subjects. Nutri Metab Cardiovas 2005, 15:188-197.
• [20]Chan R, Leung J, Woo J: A Prospective Cohort Study Examining the Associations of Dietary Calcium Intake with All-Cause and Cardiovascular Mortality in Older Chinese Community-Dwelling People. PLoS One 2013, 8:e80895.
• [21]Dai Q, Shu X, Deng X, Xiang Y, Li H, Yang G, Shrubsole MJ, Ji B, Cai H, Chow W: Modifying effect of calcium/magnesium intake ratio and mortality: a population-based cohort study. BMJ open 2013, 3:e002111.
• [22]Michaëlsson K, Melhus H, Lemming EW, Wolk A, Byberg L: Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. BMJ 2013, 346:f228.
• [23]Xiao Q, Murphy RA, Houston DK, Harris TB, Chow W-H, Park Y: Dietary and supplemental calcium intake and cardiovascular disease mortality: the National Institutes of Health–AARP Diet and Health Study. JAMA 2013, 173:639-646.
• [24]Van Hemelrijck M, Michaelsson K, Linseisen J, Rohrmann S: Calcium intake and serum concentration in relation to risk of cardiovascular death in NHANES III. PLoS One 2013, 8:e61037.
• [25]Li K, Kaaks R, Linseisen J, Rohrmann S: 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). Heart 2012, 98:920-925.
• [26]Van der Vijver L, van der Waal M, Weterings K, Dekker J, Schouten E, Kok F: Calcium intake and 28-year cardiovascular and coronary heart disease mortality in Dutch civil servants. Int J Epidemiol 1992, 21:36-39.
• [27]Mursu J, Robien K, Harnack LJ, Park K, Jacobs DR Jr: Dietary supplements and mortality rate in older women: the Iowa Women’s Health Study. Arch Intern Med 2011, 171:1625-1633.
• [28]Langsetmo L, Berger C, Kreiger N, Kovacs CS, Hanley DA, Jamal SA, Whiting SJ, Genest J, Morin SN, Hodsman A: Calcium and vitamin D intake and mortality: results from the Canadian Multicentre Osteoporosis Study (CaMos). J Clin Endocr Metab 2013, 98:3010-3018.
• [29]Cashman KD: Diet, nutrition, and bone health. J Nutr 2007, 137:2507S-2512S.
• [30]Anderson JL, May HT, Horne BD, Bair TL, Hall NL, Carlquist JF, Lappe DL, Muhlestein JB: Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population. Am J Cardiol 2010, 106:963-968.
• [31]Wang L, Song Y, Manson JE, Pilz S, Marz W, Michaelsson K, Lundqvist A, Jassal SK, Barrett-Connor E, Zhang C, Eaton CB, May HT, Anderson JL, Sesso HD: Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: a meta-analysis of prospective studies. Circ-Cardiovasc Qual 2012, 5:819-829.
• [32]Larsson SC, Virtamo J, Wolk A: Potassium, calcium, and magnesium intakes and risk of stroke in women. Am J Epidemiol 2011, 174:35-43.
• [33]Zhang W, Iso H, Ohira T, Date C, Tamakoshi A: Associations of dietary magnesium intake with mortality from cardiovascular disease: the JACC study. Atherosclerosis 2012, 221:587-595.
• [34]Kousa A, Havulinna AS, Moltchanova E, Taskinen O, Nikkarinen M, Eriksson J, Karvonen M: Calcium:magnesium ratio in local groundwater and incidence of acute myocardial infarction among males in rural Finland. Environ Health Persp 2006, 114:730-734.
• [35]Paik JM, Curhan GC, Sun Q, Rexrode KM, Manson JE, Rimm EB, Taylor EN: Calcium supplement intake and risk of cardiovascular disease in women. Osteoporos Int 2014, 25:2047-2056.
• [36]Balluz LSKS, Philen RM, Mulinare J: Vitamin and mineral supplement use in the United States. Results from the third National Health and Nutrition Examination Survey. Arch Fam Med 2000, 9:258-262.
• [37]Iso H, Stampfer MJ, Manson JE, Rexrode K, Hennekens CH, Colditz GA, Speizer FE, Willett WC: Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Stroke 1999, 30:1772-1779.
• [38]Ministers NC: Nordic Nutrition Recommendations 2004: Integrating Nutrition and Physical Activity.Nord Counc Minist 2005.
• [39]Larsson SC, Orsini N, Wolk A: Dietary calcium intake and risk of stroke: a dose–response meta-analysis. Am J Clin Nutr 2013, 97:951-957.
• [40]Bolland MJ, Grey A, Gamble GD, Reid IR: Calcium and vitamin D supplements and health outcomes: a reanalysis of the Women’s Health Initiative (WHI) limited-access data set. Am J Clin Nutr 2011, 94:1144-1149.
• [41]Wang L, Manson JE, Sesso HD: Calcium intake and risk of cardiovascular disease. Am J Cardiovasc Drug 2012, 12:105-116.
• [42]Keum N, Aune D, Greenwood DC, Ju W, Giovannucci EL: Calcium intake and colorectal cancer risk: dose–response meta-analysis of prospective observational studies.Int J Cancer 2014 [Epub ahead of print].
• [43]Bristow SM, Bolland MJ, MacLennan GS, Avenell A, Grey A, Gamble GD, Reid IR: Calcium supplements and cancer risk: a meta-analysis of randomised controlled trials. Br J Nutr 2013, 110:1384-1393.
• [44]Heaney RP, Kopecky S, Maki KC, Hathcock J, Mackay D, Wallace TC: A review of calcium supplements and cardiovascular disease risk. Adv Nutr 2012, 3:763-771.
• [45]Radford LT, Bolland MJ, Gamble GD, Grey A, Reid IR: Subgroup analysis for the risk of cardiovascular disease with calcium supplements. Bonekey Rep 2013, 2:293.
• [46]Reid IR, Bolland MJ: Calcium supplements: bad for the heart? Heart 2012, 98:895-896.
• [47]Mundy GR, Guise TA: Hormonal control of calcium homeostasis. Clin Chem 1999, 45:1347-1352.
• [48]Peacock M: Calcium metabolism in health and disease. Clin J Am Soc Nephro 2010, 5:S23-S30.
• [49]Resnick LM: The role of dietary calcium in hypertension A hierarchal overview. Am J Hypertens 1999, 12:99-112.
• [50]Allender P, Cutler J, Follmann D, Cappuccio F, Pryer J, Elliott P: Dietary calcium and blood pressure: a meta-analysis of randomized clinical trials. Ann Intern Med 1996, 124:825-831.
• [51]Zemel MB: Nutritional and endocrine modulation of intracellular calcium: implications in obesity, insulin resistance and hypertension. Mol Cell Biochem 1998, 188:129-136.
• [52]Draznin B: Intracellular calcium, insulin secretion, and action. Am J Med 1988, 85:44-58.
• [53]Rautiainen S, Wang L, Manson JE, Sesso HD: The role of calcium in the prevention of cardiovascular disease—a review of observational studies and randomized clinical trials. Curr Atheroscler Rep 2013, 15:1-23.
• [54]Leifsson B, Ahren B: Serum calcium and survival in a large health screening program. J Clin Endocr Metab 1996, 81:2149-2153.
• [55]Reid IR: Cardiovascular effects of calcium supplements. Nutrients 2013, 5:2522-2529.
• [56]Ärnlöv J, Carlsson AC, Sundström J, Ingelsson E, Larsson A, Lind L, Larsson TE: Higher fibroblast growth factor-23 increases the risk of all-cause and cardiovascular mortality in the community. Kidney Int 2012, 83:160-166.
• [57]Dalal M, Sun K, Cappola AR, Ferrucci L, Crasto C, Fried LP, Semba RD: Relationship of serum fibroblast growth factor 23 with cardiovascular disease in older community-dwelling women. Eur J Endocrinol 2011, 165:797-803.
• [58]Ix JH, Katz R, Kestenbaum BR, de Boer IH, Chonchol M, Mukamal KJ, Rifkin D, Siscovick DS, Sarnak MJ, Shlipak MG: Fibroblast growth factor-23 and death, heart failure, and cardiovascular events in community-living individuals: CHS (Cardiovascular Health Study). J Am Coll Cardiol 2012, 60:200-207.
• [59]Vervloet MG, van Ittersum FJ, Büttler RM, Heijboer AC, Blankenstein MA, ter Wee PM: Effects of dietary phosphate and calcium intake on fibroblast growth factor-23. Clin J Am Soc Nephro 2011, 6:383-389.
• [60]Wang TK, Bolland MJ, Pelt NC, Horne AM, Mason BH, Ames RW, Grey AB, Ruygrok PN, Gamble GD, Reid IR: Relationships between vascular calcification, calcium metabolism, bone density, and fractures. J Bone Miner Res 2010, 25:2777-2785.
• [61]Spence LA, Weaver CM: Calcium intake, vascular calcification, and vascular disease. Nutr Rev 2013, 71:15-22.
• [62]Seely S: Is calcium excess in Western diet a major cause of arterial disease? Int J Cardiol 1991, 33:191-198.
• [63]Livingstone KM, Lovegrove JA, Cockcroft JR, Elwood PC, Pickering JE, Givens DI: Does dairy food intake predict arterial stiffness and blood pressure in men? Evidence from the Caerphilly Prospective Study. Hypertension 2013, 61:42-47.