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Calcium supplements linked to worsening heart valve disease

Tuesday April 26th 2022

Calcium supplements are linked to worsening aortic valve stenosis among older people – and an increased risk of earlier death, new US research published today has found.

The risks have been identified of whether or not the supplements are combined with vitamin D.

The association between dietary and supplemental calcium or vitamin D with cardiovascular disease risk and death is unclear, with evidence on their safety mostly derived from animal studies. However, prescribing for both of these supplements has risen sharply in recent years, particularly among postmenopausal women.

The researchers, from Cleveland Clinic Foundation, Cleveland, Ohio, wanted to see what potential impact these supplements might have on death from any cause and from cardiovascular disease, the need for aortic valve replacement (AVR), as well as progression of aortic stenosis among older people.

They tracked the heart health of 2657 patients, whose average age was 74 and 42% of whom were women. All had mild to moderate aortic stenosis between 2008 and 2018 and they were monitored for an average of more than 5.5 years.

Participants were split into four groups: those not taking any supplements (1292; 49%), those supplemented with vitamin D alone (332; 12%), and those given calcium plus or minus vitamin D supplements (1033; 39%), 115 of whom took just a calcium supplement.

Those taking supplements had significantly more diabetes and coronary artery disease than those not taking supplements. They were also more likely to be taking statins, warfarin, and phosphate binders, to have had a coronary artery bypass graft and to need kidney dialysis.

During the monitoring period, 540 (20.5%) people died: 150 of cardiovascular disease and 155 from other causes, while 235 died of unknown causes and 774 (29%) people had their aortic valve replaced.

More than one third of people in each of the groups developed severe aortic stenosis after five years.

Supplemental vitamin D alone did not seem to affect survival, but supplemental calcium plus vitamin D was associated with a 31% higher risk of death from any cause and a doubling in the risk of a cardiovascular death. It was also associated with a 48% heightened risk of AVR compared with those not taking supplements.

Supplemental calcium alone was also associated with a 24% heightened risk of death from any cause and a near tripling in the risk of AVR.

The risks of death from any cause and from cardiovascular disease were also higher among those taking calcium supplements who did not have their aortic valve replaced.

While this is an observational study and those taking supplements also had more risk factors for heart disease and death than those who were not, the researchers nevertheless conclude: “Strengthened by its large sample size and extended follow-up period, our study suggests that calcium supplementation does not confer any [cardiovascular] benefit, and instead may reflect an elevated overall risk of AVR and mortality, especially in those not undergoing AVR.”

Kassis N, Hariri EH, Karrthik AK et al. Supplemental calcium and vitamin D and long-term mortality in aortic stenosis. *Heart* 26 April 2022; doi:10.1136/heartjnl-2021-320215

[abstract]

Tags: Diet & Food | Elderly Health | Heart Health | North America

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