Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis.
Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis.
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DOI：
10.1136/bmj.c3691
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发表时间：
2010-07-29
期刊：
影响因子：
--
通讯作者：
Reid IR
中科院分区：
文献类型：
--
作者：
Bolland MJ;Avenell A;Baron JA;Grey A;MacLennan GS;Gamble GD;Reid IR
目的探讨补钙是否增加心血管事件的危险性。设计患者水平和试验水平的荟萃分析。数据来源Medline、Embase和科克伦对照试验中心登记处（1966年-2010年3月）、钙补充剂荟萃分析参考列表和两个临床试验登记处。2007年11月进行了初步检索，2010年3月再次进行了电子数据库检索。研究选择合格的研究是钙补充剂（≥500 mg/天）的随机、安慰剂对照试验，有100名或更多平均年龄超过40岁的参与者，研究持续时间超过1年。合格试验的主要作者提供了数据。心血管结局从自我报告、住院和死亡证明中获得。结果15项试验符合纳入条件，5项具有患者水平数据（8151例受试者，中位随访时间3.6年，四分位距2.7-4.3年），11项具有试验水平数据（11921例受试者，平均持续时间4.0年）。在提供患者水平数据的五项研究中，143名分配给钙剂组的患者发生心肌梗死，而111名分配给安慰剂组（风险比1.31，95%置信区间1.02至1.67，P=0.035）。卒中的发生率（1.20，0.96 - 1.50，P=0.11）、心肌梗死、卒中或猝死的复合终点（1.18，1.00 - 1.39，P=0.057）和死亡（1.09，0.96 - 1.23，P=0.18）无显著增加。试验水平数据的荟萃分析显示了相似的结果：296人发生心肌梗死（166人分配到钙组，130人分配到安慰剂组），在分配到钙组的患者中心肌梗死的发生率增加（合并相对风险1.27，95%置信区间1.01至1.59，P=0.038）。结论：钙补充剂（不同时服用维生素D）与心肌梗死风险增加有关。随着钙补充剂的广泛使用，这些心血管疾病风险的适度增加可能会转化为人口的巨大疾病负担。有必要重新评估钙补充剂在骨质疏松症治疗中的作用。
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 (≥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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