Article

Systematic review: Vitamin D and calcium supplementation in prevention of cardiovascular events

Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts 02215, USA.
Annals of internal medicine (Impact Factor: 16.1). 03/2010; 152(5):315-23. DOI: 10.1059/0003-4819-152-5-201003020-00010
Source: PubMed

ABSTRACT Vitamin D and calcium may affect the cardiovascular system independently and interactively.
To assess whether vitamin D and calcium supplements reduce the risk for cardiovascular events in adults.
Studies published in English from 1966 to July 2009 in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials.
Two investigators independently selected 17 prospective studies and randomized trials that examined vitamin D supplementation, calcium supplementation, or both and subsequent cardiovascular events.
Three investigators extracted and checked data about study designs, participants, exposures or interventions, outcomes, and data quality.
Five prospective studies of patients receiving dialysis and 1 study involving a general population showed consistent reductions in cardiovascular disease (CVD) mortality among adults who received vitamin D supplements. Four prospective studies of initially healthy persons found no differences in incidence of CVD between calcium supplement recipients and nonrecipients. Results of secondary analyses in 8 randomized trials showed a slight but statistically nonsignificant reduction in CVD risk (pooled relative risk, 0.90 [95% CI, 0.77 to 1.05]) with vitamin D supplementation at moderate to high doses (approximately 1000 IU/d) but not with calcium supplementation (pooled relative risk, 1.14 [CI, 0.92 to 1.41]), or a combination of vitamin D and calcium supplementation (pooled relative risk, 1.04 [CI, 0.92 to 1.18]) compared with placebo.
Only articles published in English that reported cardiovascular event outcomes were included. The small number of studies, the lack of trials designed specifically to assess primary effects on cardiovascular outcomes, and important between-study heterogeneity preclude definitive conclusions.
Evidence from limited data suggests that vitamin D supplements at moderate to high doses may reduce CVD risk, whereas calcium supplements seem to have minimal cardiovascular effects. Further research is needed to elucidate the role of these supplements in CVD prevention.
The American Heart Association and the National Heart, Lung, and Blood Institute.

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    • "Arguably, the optimal approach to moderating PTH in support of vascular and bone health may be to employ effective vitamin D supplementation, while keeping calcium intake moderate so that relatively high serum levels of both calcitriol and calcidiol are maintained. A meta-analysis of randomized trials and prospective studies concludes that vitamin D supplementation is associated with a reduction in cardiovascular events, whereas no such benefit is seen with supplemental calcium [123]. In patients on hemodialysis, as in the general population, poor vitamin D status is associated with increased vascular risk, possibly reflecting a role for vitamin D in control of PTH [124]. "
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