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)
Kuanrong Li1, Rudolf Kaaks1, Jakob Linseisen1,2, Sabine Rohrmann1,3
– Author Affiliations
1.Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
2.Institute of Epidemiology, Helmholtz Centre Munich, Neuherberg, Germany
3.Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Switzerland
Professor Sabine Rohrmann, Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland; firstname.lastname@example.org
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.
To prospectively evaluate the associations of dietary calcium intake and calcium supplementation with MI and stroke risk and overall CVD mortality.
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.
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).
Increasing calcium intake from diet might not confer significant cardiovascular benefits, while calcium supplements, which might raise MI risk, should be taken with caution.