Calcium Heart Controversy

June 25, 2010 Written by JP       [Font too small?]

I was recently asked whether supplementing with calcium increases the risk of calcium deposits in coronary arteries. If the answer to this question is “yes”, then a good portion of modern society could be compromising its cardiovascular system in an attempt to ward off osteoporosis. In order to give an up-to-date and fully informed response to this inquiry I immersed myself in a number of medical studies that have explored this topic.

The June 14th issue of the journal Menopause provides the most current and thorough evaluation of the role that supplemental calcium plays in coronary calcification. A total of 754 middle-aged women were randomized into two groups. The first was asked to take 1,000 mg of calcium carbonate and 400 IUs of Vitamin D3 daily. The control group was given a placebo with no nutritive value. All of the women took part in imaging tests (cardiac CTs) at the end of the trial period which lasted approximately 7 years. The tests specifically assessed the degree of coronary artery calcium (CAC). The findings revealed that the CAC scores of those receiving added calcium + Vitamin D3 were slightly or non-significantly lower than those receiving a placebo. The concluding remarks of the study authors state that, “Treatment with moderate doses of calcium plus Vitamin D3 did not seem to alter coronary artery calcified plaque burden among postmenopausal women”. (1)

Three other relevant studies seem to support the above mentioned results. A Mayo Clinic trial published in December 2009 similarly found no difference in aortic valve and coronary artery calcification in senior women using calcium supplements over a 4 year follow up period. A Japanese cohort study from September 2008, involving 41,526 middle-aged men and women, determined that higher calcium intake actually reduced the risk of stroke and “was not significantly associated with risk of coronary heart disease”. Last, but not least, is an older trial that was published in 1998 in the journal Coronary Artery Disease. Researchers used electron beam computed tomography to assess calcium deposits in the arteries of 50 men and women. They also measured their plasma levels of calcium and Vitamin D. The results indicate that “Serum concentrations of calcium, 1,25(OH)2 Vitamin D and PTH (parathyroid hormone) were not correlated with coronary calcification”. (2,3,4)

The Effect of Supplemental Calcium on Arterial Calcification


Source: J Am Board Fam Med. 2009 Nov-Dec;22(6):610-6. (link)

Based on the information that’s presently available, it’s reasonable to assume that dietary and supplemental calcium does not promote calcification of the coronary arteries. That’s certainly comforting to know. But are there any natural means of potentially slowing the progression of calcium build-up in arterial plaque? Here’s what modern science has to say:

  • Aged Garlic Extract has generated some buzz in the field of preventive cardiology. Two peer-reviewed, published studies provide evidence that an aged garlic extract (Kyolic) alone or in concert with other nutrients “is associated with a favorable improvement in oxidative biomarkers, vascular function, and reduced progression of atherosclerosis”. (5,6,7)
  • Higher blood concentrations of Vitamin D have been inversely associated with the development of coronary artery calcification in at least three studies. The ideal plasma levels of D have yet to be determined. However one investigation suggests that a Vitamin D concentration of at least 50 pg/ml may yield the greatest protection. (8,9,10)
  • Vitamin K may also be of benefit according to several scientific inquiries. The most recent of which found that supplementing with 500 mcg of phylloquinone (Vitamin K1) daily effectively slowed the rate of coronary calcification in those with pre-existing coronary calcium. Population-based studies have also demonstrated that dietary Vitamin K2 (menaquinone) may also protect against coronary heart disease. (11,12,13)

My initial reason for writing today’s column was to answer a specific question posed by a valued reader. But as you many of you now, I often times can’t help but add additional information into the mix. When I come across studies that show that drinking moderate to high amounts of coffee and maintaining optimal Vitamin C levels can reduce the risk of developing coronary calcium deposits, I feel compelled to let you know. The incredible truth is that there are countless scientific gems that are buried away in the medical literature. It’s like a tantalizing secret that’s begging to be told, and I consider it a distinct privilege to be able to have a forum to share my discoveries with you. (14,15)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

Bookmark and Share


Related Posts:

Tags: , ,
Posted in Bone and Joint Health, Nutritional Supplements, Women's Health

19 Comments & Updates to “Calcium Heart Controversy”

  1. Nina K. Says:

    Good Morning, JP :-)

    ☼☼☼ wish you and yours a relaxing weekend ☼☼☼

    Nina K.

  2. JP Says:

    Thank you, Nina.

    I wish you both the same. :)

    Be well!

    JP

  3. liverock Says:

    Very interesting and timely article on the day that the actress Gwyneth Paltrow, has been diagnosed with osteoporosis with what her doctor says is ” The lowest vitamin D level he has ever seen.”
    Maybe the publicity will encourage more younger women to get their Vitamin D levels checked. Most young women think its a disease only the elderly suffer from.

  4. Paul Says:

    Hi JP,

    Very valuable, reassuring information.

    Does it apply as well to premenopausa women?

    Thank you for your constant search for gems and making them available to us!

    Regards,

    Paul

  5. JP Says:

    That’s quite shocking, Liverock. 37?! So young.

    Here’s a link to a story about Gwyneth’s osteopenia revelation:

    http://www.dailymail.co.uk/tvshowbiz/article-1289644/Gwyneth-Paltrow-Im-suffering-brittle-bone-disease.html

    Thanks for bringing this to our attention. It’s a good reminder for us all to have our Vitamin D levels tested.

    Be well!

    JP

  6. JP Says:

    Thank you, Paul. :)

    Hopefully similar results will apply to premenopausal women as well. Future studies will help confirm this. I’ll be on the look out for any relevant data and report back when I find it.

    Be well!

    JP

  7. liverock Says:

    Dr William Davis at heartscanblog appears to be getting cases where some of his patients who have high vitamin D levels (60-70ng)and who take 1,200mg of calcium are getting hypercalcemia.

    He is now recommending that none of his patients take more than 600mg of calcium.

    http://heartscanblog.blogspot.com/search/label/Calcium

  8. JP Says:

    Thank you for the heads up on this, Liverock!

    Dr. Davis is certainly on the cutting edge. I take his observations seriously.

    I suppose this is another reason to have regular blood testing – to measure both calcium and D concentrations.

    Be well!

    JP

  9. liverock Says:

    JP
    The major flaw in the menopausal studies appear to be the lack of consideration that estrogen plays in calcium absorption for older women. Calcium absorption tapers off considerably in proportion to estrogen decline till barely any calcium is being absorped at menopause. If estrogen supplementation is carried after menopause then calcium levels will of course increase. Maybe these are the women who get heart disease from calcium supplementation. Not appearing to allow for the effect of estrogen on calcium absorption appears to seriously undermines the results of the study.

    http://www.ncbi.nlm.nih.gov/pubmed/2816496

  10. JP Says:

    An interesting point, Liverock. Thank you for making it.

    Perhaps this argues in favor of using plant-based compounds with estrogenic activity such as isoflavones and supportive nutrients that are involved in maintaining bone density – boron, Vitamin K, etc.

    Be well!

    JP

  11. Tom Says:

    Because you wrote…

    “When I come across studies that show that drinking moderate to high amounts of coffee and maintaining optimal Vitamin C levels can reduce the risk of developing coronary calcium deposits, I feel compelled to let you know.”

    I feel I must ask you to read “Vitamin K2 and the Calcium Paradox” by Dr. Kate Rheaume-Bleue which will can directly address many aspects of the coronary calcium deposit question in a nutritional way. If any one else is reading this – you need to read her summary of the Vitamin K2 findings…

    Regards..
    TW

  12. JP Says:

    An update from the scientific literature:

    http://www.ncbi.nlm.nih.gov/pubmed/25042841

    J Bone Miner Res. 2014 Jul 10. doi: 10.1002/jbmr.2311. [Epub ahead of print]

    The Effects of Calcium Supplementation on Verified Coronary Heart Disease Hospitalization and Death in Postmenopausal Women: A Collaborative Meta-Analysis of Randomized Controlled Trials.

    Lewis JR1, Radavelli-Bagatini S, Rejnmark L, Chen JS, Simpson JM, Lappe JM, Mosekilde L, Prentice RL, Prince RL.

    Calcium supplementation, particularly with vitamin D has been an approved public health intervention to reduce fracture risk. Enthusiasm for this intervention has been mitigated by meta-analyses suggesting calcium supplementation with or without vitamin D increase myocardial infarction (MI) risk; however concern has been raised over the design of these meta-analyses. We therefore undertook a meta-analysis of randomized controlled trials with placebo or no-treatment control groups to determine if these supplements increase all-cause mortality and coronary heart disease (CHD) risk including: MI, angina pectoris and acute coronary syndrome, and chronic CHD verified by clinical review, hospital record or death certificate in elderly women. The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases were searched from January 1, 1966 to May 24, 2013 for potentially eligible studies, reference lists were checked, and trial investigators contacted where additional unpublished data was required. The search yielded 661 potentially eligible reports of which 18 met the inclusion criteria and contributed information on 63,563 participants with 3,390 CHD events and 4,157 deaths. Two authors extracted the data independently with trial data combined using random-effects meta-analysis to calculate the relative risk (RR). Five trials contributed CHD events with pooled relative RR of 1.02 (95% CI, 0.96-1.09; P = 0.51). Seventeen trials contributed all-cause mortality data with pooled RR of 0.96 (95%CI, 0.91-1.02; P = 0.18). Heterogeneity among the trials was low for both primary outcomes (I2  = 0%). For secondary outcomes the RR for MI was 1.08; 95% CI, 0.92-1.26; P = 0.32, angina pectoris and acute coronary syndrome 1.09; 95% CI, 0.95-1.24; P = 0.22 and chronic CHD 0.92; 95% CI, 0.73-1.15; P = 0.46. In conclusion, current evidence does not support the hypothesis that calcium supplementation with or without vitamin D increase coronary heart disease or all-cause mortality risk in elderly women.

    Be wel1!

    JP

  13. JP Says:

    Update: Vitamin K2 (MK-7) improves arterial stiffness in older women …

    http://www.ncbi.nlm.nih.gov/pubmed/25694037

    Thromb Haemost. 2015 Feb 19;113(5).

    Menaquinone-7 supplementation improves arterial stiffness in healthy postmenopausal women: double-blind randomised clinical trial.

    Observational data suggest a link between menaquinone (MK, vitamin K2) intake and cardiovascular (CV) health. However, MK intervention trials with vascular endpoints are lacking. We investigated long-term effects of MK-7 (180 µg MenaQ7/day) supplementation on arterial stiffness in a double-blind, placebo-controlled trial. Healthy postmenopausal women (n=244) received either placebo (n=124) or MK-7 (n=120) for three years. Indices of local carotid stiffness (intima-media thickness IMT, Diameter end-diastole and Distension) were measured by echotracking. Regional aortic stiffness (carotid-femoral and carotid-radial Pulse Wave Velocity, cfPWV and crPWV, respectively) was measured using mechanotransducers. Circulating desphospho-uncarboxylated matrix Gla-protein (dp-ucMGP) as well as acute phase markers Interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP), tumour necrosis factor-α (TNF-α) and markers for endothelial dysfunction Vascular Cell Adhesion Molecule (VCAM), E-selectin, and Advanced Glycation Endproducts (AGEs) were measured. At baseline dp-ucMGP was associated with IMT, Diameter, cfPWV and with the mean z-scores of acute phase markers (APMscore) and of markers for endothelial dysfunction (EDFscore). After three year MK-7 supplementation cfPWV and the Stiffness Index β significantly decreased in the total group, whereas distension, compliance, distensibility, Young’s Modulus, and the local carotid PWV (cPWV) improved in women having a baseline Stiffness Index β above the median of 10.8. MK-7 decreased dp-ucMGP by 50 % compared to placebo, but did not influence the markers for acute phase and endothelial dysfunction. In conclusion, long-term use of MK-7 supplements improves arterial stiffness in healthy postmenopausal women, especially in women having a high arterial stiffness.

    Be well!

    JP

  14. JP Says:

    Update: A recent, scientific review …

    http://onlinelibrary.wiley.com/doi/10.1002/jbmr.2311/full

    The Effects of Calcium Supplementation on Verified Coronary Heart Disease Hospitalization and Death in Postmenopausal Women: A Collaborative Meta-Analysis of Randomized Controlled Trials

    Calcium supplementation, particularly with vitamin D, has been an approved public health intervention to reduce fracture risk. Enthusiasm for this intervention has been mitigated by meta-analyses suggesting that calcium supplementation with or without vitamin D increases myocardial infarction (MI) risk; however, concern has been raised over the design of these meta-analyses. We, therefore, undertook a meta-analysis of randomized controlled trials with placebo or no-treatment control groups to determine if these supplements increase all-cause mortality and coronary heart disease (CHD) risk including MI, angina pectoris and acute coronary syndrome, and chronic CHD verified by clinical review, hospital record, or death certificate in elderly women. The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases were searched from January 1, 1966, to May 24, 2013, for potentially eligible studies, reference lists were checked, and trial investigators were contacted where additional unpublished data were required. The search yielded 661 potentially eligible reports of which 18 met the inclusion criteria and contributed information on 63,563 participants with 3390 CHD events and 4157 deaths. Two authors extracted the data independently with trial data combined using random-effects meta-analysis to calculate the relative risk (RR). Five trials contributed CHD events with pooled relative RR of 1.02 (95% confidence interval [CI], 0.96–1.09; p = 0.51). Seventeen trials contributed all-cause mortality data with pooled RR of 0.96 (95% CI, 0.91–1.02; p = 0.18). Heterogeneity among the trials was low for both primary outcomes (I2 = 0%). For secondary outcomes, the RR for MI was 1.08 (95% CI, 0.92–1.26; p = 0.32), angina pectoris and acute coronary syndrome 1.09 (95% CI, 0.95–1.24; p = 0.22) and chronic CHD 0.92 (95% CI, 0.73–1.15; p = 0.46). In conclusion, current evidence does not support the hypothesis that calcium supplementation with or without vitamin D increases coronary heart disease or all-cause mortality risk in elderly women.

    More info: http://www.nutraingredients-usa.com/Research/Meta-analysis-rejects-safety-concerns-over-calcium-supplementation-for-increasing-coronary-heart-disease-risk

    Be well!

    JP

  15. JP Says:

    Update: Dietary calcium may lower cardiovascular and all-cause mortality risk in older adults …

    http://onlinelibrary.wiley.com/doi/10.1002/jbmr.2515/abstract

    J Bone Miner Res. 2015 Mar 31.

    Higher Dietary Calcium Intakes are Associated With Reduced Risks of Fractures, Cardiovascular Events and Mortality: A Prospective Cohort Study of Older Men and Women.

    The aim of this population-based, prospective cohort study was to investigate long-term associations between dietary calcium intake and fractures, non-fatal cardiovascular disease (CVD), and death from all causes. Participants were from the Melbourne Collaborative Cohort Study which was established in 1990-1994. A total of 41,514 men and women (∼99% aged 40-69 years at baseline) were followed-up for a mean (SD) of 12 (1.5) years. Primary outcome measures were time to death from all causes (n = 2,855), CVD-related deaths (n = 557), cerebrovascular disease-related deaths (n = 139), incident non-fatal CVD (n = 1,827), incident stroke events (n = 537) and incident fractures (n = 788). 12,097 participants (aged ≥50 years) were eligible for fracture analysis and 34,468 for non-fatal CVD and mortality analyses. Mortality was ascertained by record linkage to registries. Fractures and CVD were ascertained from interview ∼13 years after baseline. Quartiles of baseline energy-adjusted calcium intake from food were estimated using a food frequency questionnaire. Hazard ratios (HR) and odds ratios (OR) were calculated for quartiles of dietary calcium intake. Highest and lowest quartiles of energy-adjusted dietary calcium intakes represented unadjusted means (SD) of 1,348 (316) mg/d and 473 (91) mg/d, respectively. Overall there were 788 (10.3%) incident fractures, 1,827 (9.0%) incident CVD; and 2,855 people (8.6%) died. Comparing the highest with the lowest quartile of calcium intake, for all-cause mortality, the HR was 0.86 (95%CI; 0.76 to 0.98, Ptrend  = 0.01);for non-fatal CVD and stroke, the OR was 0.84 (95%CI; 0.70 to 0.99, Ptrend  = 0.04) and 0.69 (95%CI; 0.51 to 0.93, Ptrend  = 0.02), respectively, and the OR for fracture was 0.70 (95%CI; 0.54 to 0.92, Ptrend  = 0.004). In summary, for older men and women, calcium intakes of up to 1,348 (316) mg/d from food were associated with decreased risks for fracture, non-fatal CVD, stroke and all-cause mortality.

    Be well!

    JP

  16. JP Says:

    Update: The role that calcium and hydration play in kidney stone formation …

    http://www.tandfonline.com/doi/full/10.1080/07315724.2014.959207#abstract

    J Am Coll Nutr. 2015 Apr 9:1-7.

    Effects of Hydration and Calcium Supplementation on Urine Calcium Concentration in Healthy Postmenopausal Women.

    OBJECTIVE: The aim of this study was to determine whether calcium supplementation, compared with placebo, increases urine calcium concentrations to levels indicative of increased renal stone risk, and the role that fluid intake, as indicated by urine volume, may play in mitigating this risk.

    METHODS: This is a secondary analysis of data from a randomized placebo-controlled trial of 500 mg/d calcium supplementation to prevent bone loss. Subjects were 240 white postmenopausal women age 40 to 70 years in good general health. Effects of supplementation on 1-year changes in 24h urine calcium concentration and urine volume were examined.

    RESULTS: Both treatment group and urine volume were strong independent predictors of urine calcium concentration (p < 0.001). Among subjects with urine volume under 2 L/24 h, more than half of placebo subjects were at lowest risk for renal stones compared with less than 35% of calcium-supplemented subjects. Among those with higher urine volumes, all placebo subjects and more than 80% of calcium supplemented subjects were at lowest risk.

    CONCLUSIONS: The increased risk of renal stones with calcium supplement use may be largely eliminated with adequate fluid intake, but older adults may not spontaneously consume adequate fluids to minimize this risk and should be counseled to do so.

    Be well!

    JP

  17. JP Says:

    Updated 06/15/16:

    http://www.ahjonline.com/article/S0002-8703%2816%2930023-0/abstract

    Am Heart J. 2016 Jul;177:17-24.

    Sugar-sweetened carbonated beverage consumption and coronary artery calcification in asymptomatic men and women.

    BACKGROUND: Sugar-sweetened carbonated beverage consumption has been linked to obesity, metabolic syndrome, type 2 diabetes, and clinically manifest coronary heart disease, but its association with subclinical coronary heart disease remains unclear. We investigated the relationship between sugar-sweetened carbonated beverage consumption and coronary artery calcium (CAC) in a large study of asymptomatic men and women.

    METHODS: This was a cross-sectional study of 22,210 adult men and women who underwent a comprehensive health screening examination between 2011 and 2013 (median age 40 years). Sugar-sweetened carbonated beverage consumption was assessed using a validated food frequency questionnaire, and CAC was measured by cardiac computed tomography. Multivariable-adjusted CAC score ratios and 95% CIs were estimated from robust Tobit regression models for the natural logarithm (CAC score +1).

    RESULTS: The prevalence of detectable CAC (CAC score >0) was 11.7% (n = 2,604). After adjustment for age; sex; center; year of screening examination; education level; physical activity; smoking; alcohol intake; family history of cardiovascular disease; history of hypertension; history of hypercholesterolemia; and intake of total energy, fruits, vegetables, and red and processed meats, only the highest category of sugar-sweetened carbonated beverage consumption was associated with an increased CAC score compared with the lowest consumption category. The multivariable-adjusted CAC ratio comparing participants who consumed ≥5 sugar-sweetened carbonated beverages per week with nondrinkers was 1.70 (95% CI, 1.03-2.81). This association did not differ by clinical subgroup, including participants at low cardiovascular risk.

    CONCLUSION: Our findings suggest that high levels of sugar-sweetened carbonated beverage consumption are associated with a higher prevalence and degree of CAC in asymptomatic adults without a history of cardiovascular disease, cancer, or diabetes.

    Be well!

    JP

  18. JP Says:

    Updated 10/08/16:

    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0163673

    PLoS One. 2016 Sep 23;11(9):e0163673.

    Association between Density of Coronary Artery Calcification and Serum Magnesium Levels among Patients with Chronic Kidney Disease.

    BACKGROUND: The Agatston score, commonly used to quantify coronary artery calcification (CAC), is determined by the plaque area and density. Despite an excellent predictability of the Agatston score for cardiovascular events, the density of CAC has never been studied in patients with pre-dialysis chronic kidney disease (CKD). This study aimed to analyze the CAC density and its association with serum mineral levels in CKD.

    METHODS: We enrolled patients with pre-dialysis CKD who had diabetes mellitus, prior cardiovascular disease history, elevated low-density lipoprotein cholesterol levels, or smoking history. The average CAC density was calculated by dividing the Agatston score by the total area of CAC.

    RESULTS: The mean estimated glomerular filtration rate (eGFR) of 109 enrolled patients was 35.7 mL/min/1.73 m2. The correlation of the Agatston score with density was much weaker than that with the total area (R2 = 0.19, P < 0.001; and R2 = 0.99, P < 0.001, respectively). Multivariate analyses showed that serum magnesium level was inversely associated with the density, but not with the total area, after adjustment for demographics and clinical factors related to malnutrition-inflammation-atherosclerosis syndrome and mineral and bone disorders including fibroblast growth factor 23 (P = 0.006). This inverse association was pronounced among patients with higher serum phosphate levels (P for interaction = 0.02).

    CONCLUSION: CAC density was inversely associated with serum magnesium levels, particularly in patients with higher serum phosphate levels.

    Be well!

    JP

  19. JP Says:

    Updated 10/30/16:

    http://www.amjmed.com/article/S0002-9343(16)30925-1/abstract

    Am J Med. 2016 Sep 15.

    Associations of Coffee, Tea, and Caffeine Intake with Coronary Artery Calcification and Cardiovascular Events.

    BACKGROUND: Coffee and tea are 2 of the most commonly consumed beverages in the world. The association of coffee and tea intake with coronary artery calcium and major adverse cardiovascular events remains uncertain.

    METHODS: We examined 6508 ethnically diverse participants with available coffee and tea data from the Multi-Ethnic Study of Atherosclerosis. Intake for each was classified as never, occasional (<1 cup per day), and regular (≥1 cup per day). A coronary artery calcium progression ratio was derived from mixed effect regression models using loge(calcium score+1) as the outcome, with coefficients exponentiated to reflect coronary artery calcium progression ratio versus the reference. Cox proportional hazards analyses were used to evaluate the association between beverage intake and incident cardiovascular events.

    RESULTS: Over a median follow-up of 5.3 years for coronary artery calcium and 11.1 years for cardiovascular events, participants who regularly drank tea (≥1 cup per day) had a slower progression of coronary artery calcium compared with never drinkers after multivariable adjustment. This correlated with a statistically significant lower incidence of cardiovascular events for ≥1 cup per day tea drinkers (adjusted hazard ratio 0.71; 95% confidence interval 0.53-0.95). Compared with never coffee drinkers, regular coffee intake (≥1 cup per day) was not statistically associated with coronary artery calcium progression or cardiovascular events (adjusted hazard ratio 0.97; 95% confidence interval 0.78-1.20). Caffeine intake was marginally inversely associated with coronary artery calcium progression.

    CONCLUSIONS: Moderate tea drinkers had slower progression of coronary artery calcium and reduced risk for cardiovascular events. Future research is needed to understand the potentially protective nature of moderate tea intake.

    Be well!

    JP

Leave a Comment




*
To prove you're a person (not a spam script), type the security word shown in the picture. Click on the picture to hear an audio file of the word.
Click to hear an audio file of the anti-spam word