Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis.
Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis.
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DOI：
10.1136/bmj.d2040
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发表时间：
2011-04-19
期刊：
影响因子：
--
通讯作者：
Reid IR
中科院分区：
文献类型：
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作者：
Bolland MJ;Grey A;Avenell A;Gamble GD;Reid IR
目的使用WHI数据集，调查妇女健康倡议钙/维生素D补充研究（WHI CaD研究）中个人钙补充剂使用对心血管风险的影响，并更新最近关于钙补充剂和心血管风险的荟萃分析。WHI CaD研究的设计再分析限制访问数据集，并与其他8项研究一起纳入荟萃分析。数据来源WHI CaD研究，一项为期7年的随机、安慰剂对照试验，在36282名社区居住的绝经后妇女中进行钙和维生素D（每天1g钙和400 IU维生素D）。主要结局指标采用患者水平数据和试验水平数据评估四种心血管事件及其组合（心肌梗死、冠状动脉血运重建、冠心病死亡和卒中）的发生率。结果在WHI CaD研究中，个人使用钙补充剂与分配的钙和维生素D对心血管事件之间存在相互作用。在16718名随机分组时未服用个人钙补充剂的女性（46%）中，钙和维生素D对心血管事件的风险比范围为1.13至1.22（临床心肌梗死或卒中P=0.05，临床心肌梗死或血运重建P=0.04），而在服用个人钙补充剂的妇女中，心血管风险并没有随着钙和维生素D的分配而改变。在三项安慰剂对照试验的荟萃分析中，钙和维生素D增加了心肌梗死的风险（相对风险1.21（95%置信区间1.01至1.44），P=0.04），卒中（1.20（1.00 ~ 1.43），P=0.05），心肌梗死或脑卒中复合终点（1.16（1.02 ~ 1.32），P=0.02）。在钙或钙和维生素D的安慰剂对照试验的荟萃分析中，来自8项钙补充剂试验的28072名参与者和未服用个人钙补充剂的WHI CaD参与者的完整试验水平数据可用。共有1384人发生心肌梗死或中风。钙或钙和维生素D增加心肌梗死的风险（相对风险1.24（1.07至1.45），P=0.004）和心肌梗死或卒中的复合风险（1.15（1.03至1.27），P=0.009）。结论钙补充剂与或不与维生素D适度增加心血管事件的风险，特别是心肌梗死，在WHI CaD研究中发现掩盖个人钙补充剂的广泛使用。对钙补充剂在骨质疏松症治疗中的作用进行重新评估是必要的。
Objectives To investigate the effects of personal calcium supplement use on cardiovascular risk in the Women’s Health Initiative Calcium/Vitamin D Supplementation Study (WHI CaD Study), using the WHI dataset, and to update the recent meta-analysis of calcium supplements and cardiovascular risk. Design Reanalysis of WHI CaD Study limited access dataset and incorporation in meta-analysis with eight other studies. Data source WHI CaD Study, a seven year, randomised, placebo controlled trial of calcium and vitamin D (1g calcium and 400 IU vitamin D daily) in 36 282 community dwelling postmenopausal women. Main outcome measures Incidence of four cardiovascular events and their combinations (myocardial infarction, coronary revascularisation, death from coronary heart disease, and stroke) assessed with patient-level data and trial-level data. Results In the WHI CaD Study there was an interaction between personal use of calcium supplements and allocated calcium and vitamin D for cardiovascular events. In the 16 718 women (46%) who were not taking personal calcium supplements at randomisation the hazard ratios for cardiovascular events with calcium and vitamin D ranged from 1.13 to 1.22 (P=0.05 for clinical myocardial infarction or stroke, P=0.04 for clinical myocardial infarction or revascularisation), whereas in the women taking personal calcium supplements cardiovascular risk did not alter with allocation to calcium and vitamin D. In meta-analyses of three placebo controlled trials, calcium and vitamin D increased the risk of myocardial infarction (relative risk 1.21 (95% confidence interval 1.01 to 1.44), P=0.04), stroke (1.20 (1.00 to 1.43), P=0.05), and the composite of myocardial infarction or stroke (1.16 (1.02 to 1.32), P=0.02). In meta-analyses of placebo controlled trials of calcium or calcium and vitamin D, complete trial-level data were available for 28 072 participants from eight trials of calcium supplements and the WHI CaD participants not taking personal calcium supplements. In total 1384 individuals had an incident myocardial infarction or stroke. Calcium or calcium and vitamin D increased the risk of myocardial infarction (relative risk 1.24 (1.07 to 1.45), P=0.004) and the composite of myocardial infarction or stroke (1.15 (1.03 to 1.27), P=0.009). Conclusions Calcium supplements with or without vitamin D modestly increase the risk of cardiovascular events, especially myocardial infarction, a finding obscured in the WHI CaD Study by the widespread use of personal calcium supplements. A reassessment of the role of calcium supplements in osteoporosis management is warranted.