Cited by 1,099Vitamin D Research StudiesNutritional Studies and DietBone health and osteoporosis research

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Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis

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Bolland, M. J., Avenell, A., Baron, J. A., Grey, A., MacLennan, G. S., Gamble, G. D., Reid, I. R.·2010·BMJ

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Abstract

OBJECTIVE: To investigate whether calcium supplements increase the risk of cardiovascular events. DESIGN: Patient level and trial level meta-analyses. DATA SOURCES: Medline, Embase, and Cochrane Central Register of Controlled Trials (1966-March 2010), reference lists of meta-analyses of calcium supplements, and two clinical trial registries. Initial searches were carried out in November 2007, with electronic database searches repeated in March 2010. STUDY SELECTION: Eligible studies were randomised, placebo controlled trials of calcium supplements (>or=500 mg/day), with 100 or more participants of mean age more than 40 years and study duration more than one year. The lead authors of eligible trials supplied data. Cardiovascular outcomes were obtained from self reports, hospital admissions, and death certificates. RESULTS: 15 trials were eligible for inclusion, five with patient level data (8151 participants, median follow-up 3.6 years, interquartile range 2.7-4.3 years) and 11 with trial level data (11 921 participants, mean duration 4.0 years). In the five studies contributing patient level data, 143 people allocated to calcium had a myocardial infarction compared with 111 allocated to placebo (hazard ratio 1.31, 95% confidence interval 1.02 to 1.67, P=0.035). Non-significant increases occurred in the incidence of stroke (1.20, 0.96 to 1.50, P=0.11), the composite end point of myocardial infarction, stroke, or sudden death (1.18, 1.00 to 1.39, P=0.057), and death (1.09, 0.96 to 1.23, P=0.18). The meta-analysis of trial level data showed similar results: 296 people had a myocardial infarction (166 allocated to calcium, 130 to placebo), with an increased incidence of myocardial infarction in those allocated to calcium (pooled relative risk 1.27, 95% confidence interval 1.01 to 1.59, P=0.038). CONCLUSIONS: Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.

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Bias in meta-analysis detected by a simple, graphical test
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Authors: Bolland, M. J., Avenell, A., Baron, J. A., Grey, A., MacLennan, G. S., Gamble, G. D., & Reid, I. R.
Affiliations: University of Auckland (NZ)
University of Aberdeen (GB)
Dartmouth College (US)
Corresponding author: Reid, I. R.
ORCID: Bolland, M. J.
Avenell, A.
Baron, J. A.
Grey, A.
MacLennan, G. S.
Gamble, G. D.
Reid, I. R.
Venue: BMJ
Publisher: BMJ
Published: 2010-07-29
Volume: 341
Issue: jul29 1
Pages: c3691-c3691
ISSN: 0007-1447 (ISSN-L)
0959-8138
1468-5833
DOI: 10.1136/bmj.c3691
PMC: PMC2912459
OpenAlex: W2143921117
Cited by: 1,099
References: 68
Citations by year: 2026: 13 · 2025: 21 · 2024: 25 · 2023: 35 · 2022: 29 · 2021: 34 · 2020: 53 · 2019: 55 · 2018: 59 · 2017: 59 · 2016: 73 · 2015: 81 · 2014: 114 · 2013: 134 · 2012: 112
FWCI: 17.25
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
Locations: BMJ (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
ResearchSpace (University of Auckland) (submittedVersion)
ResearchSpace (University of Auckland) (submittedVersion, cc-by-nc)
Funders: Scottish Government
University of Auckland
Fonterra Co-Operative Group
Shire
Chief Scientist Office, Scottish Government Health and Social Care Directorate
Health Research Council of New Zealand
National Cancer Institute (R01CA098286)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Vitamin D Research Studies
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
Keywords: calcium supplements, myocardial infarction, cardiovascular events, stroke, sudden death, mortality, vitamin D, older adults, cardiovascular risk, individual patient data, risk of bias assessment, subgroup analysis
MeSH terms: Adult, Aged, Calcium, Dietary, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Myocardial Infarction, Osteoporosis, Risk Factors, Vitamin D, Randomized Controlled Trials as Topic, Dietary Supplements, Stroke, Bone Density Conservation Agents

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Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis

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