Calcium Supplementation and the Risks of Atherosclerotic Vascular Disease in Older Women: Results of a 5-Year RCT and a 4.5-Year Follow-up
Calcium Supplementation and the Risks of Atherosclerotic Vascular Disease in Older Women: Results of a 5-Year RCT and a 4.5-Year Follow-up
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DOI：
10.1002/jbmr.176
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发表时间：
2011-01-01
影响因子：
6.2
通讯作者：
Prince, Richard L.
中科院分区：
文献类型：
--
作者：
Lewis, Joshua R.;Calver, Janine;Prince, Richard L.
有人担心，补钙是预防老年女性骨质疏松性骨折的关键干预措施，可能会增加动脉粥样硬化性血管疾病的风险。为了进一步评估风险，对一项为期5年的碳酸钙随机对照试验(RCT)和4.5年的试验后随访，对完全核实的动脉粥样硬化性血管住院和死亡率数据进行了检查。这项研究使用了一项已发表的为期5年的随机、双盲、安慰剂对照试验[钙摄入骨折结果研究(CAIFOS)]的数据。参与者是从普通人群中招募的1460名年龄在基线(1998年)为75.1+/-2.7岁的女性，她们被随机分配到每天服用1200毫克碳酸钙或相同的安慰剂。在为期5年的研究和4.5年的随访中，所有住院和死亡的数据都来自西澳大利亚数据链接服务(WADLS)。使用预先指定的意向治疗模型和按方案模型计算动脉粥样硬化性血管死亡或首次住院的联合终点的风险比(HR)。在5年随机对照试验[多变量调整后HR=0.938，95%可信区间(CI)0.690~1.275]或9.5年观察研究期间(多变量调整后HR=0.919，95%CI 0.737~1.146)，接受补钙的干预组因动脉粥样硬化性血管疾病而死亡或首次住院的风险并不高。进一步的分析表明，补钙可以降低既往动脉粥样硬化性心血管疾病患者的住院风险和死亡率。这项试验提供了令人信服的证据，证明每天补充1200毫克的钙并不会显著增加老年妇女患动脉粥样硬化性血管疾病的风险。(C)2011年美国骨与矿物研究学会。
Concern has been expressed that calcium supplementation, a key intervention for preventing osteoporotic fracture in older women, may increase the risk of atherosclerotic vascular disease. To evaluate the risk further, an examination of complete verified atherosclerotic vascular hospitalization and mortality data from a 5-year randomized, controlled trial (RCT) of calcium carbonate and 4.5 years of posttrial follow-up was undertaken. This study used data from a published 5-year randomized, double-blinded, placebo-controlled trial [Calcium Intake Fracture Outcome Study (CAIFOS)]. The participants were 1460 women aged 75.1 +/- 2.7 years at baseline (1998) recruited from the general population and randomized to receive 1200 mg of calcium carbonate daily or an identical placebo. All hospital admission and deaths during the 5-year study and the 4.5-year follow-up were derived from the Western Australian Data Linkage Service (WADLS). Hazard ratios (HRs) for the combined endpoint of atherosclerotic vascular mortality or first hospitalization were calculated using prespecified intention-to-treat and per-protocol models. The intervention group that received calcium supplementation did not have a higher risk of death or first-time hospitalization from atherosclerotic vascular disease in either the 5-year RCT [multivariate-adjusted HR = 0.938, 95% confidence interval (Cl) 0.690-1.275] or during the 9.5 years of observational study (multivariate-adjusted HR = 0.919, 95% Cl 0.737-1.146). Further analysis suggested that calcium supplementation may reduce the risk of hospitalization and mortality in patients with preexisting atherosclerotic cardiovascular disease. This trial provides compelling evidence that calcium supplementation of 1200 mg daily does not significantly increase the risk of atherosclerotic vascular disease in elderly women. (C) 2011 American Society for Bone and Mineral Research.