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Table of contents
1. In the journals: Link between calcium supplements and heart attack risk unclear....................................... 1

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In the journals: Link between calcium supplements and heart attack risk unclear
Publication info: Harvard Health Publications. Harvard Women's Health Watch (Oct 2010). ProQuest document link Abstract: Research regarding a link between calcium supplements and increased risk of a heart attack is contradictory, but getting most of the body's daily calcium requirement from food is preferable. Full text: In the journals Link between calcium supplements and heart attack risk unclear Older people who take calcium supplements have a 30% increased risk of heart attack, according to a metaanalysis (a review of multiple studies) published online July 29, 2010, in the medical journal BMJ. But another meta-analysis, published by Harvard researchers in Annals of Internal Medicine (March 2, 2010), found that calcium supplements had no effect on cardiovascular events. These conflicting findings have raised questions for clinicians and women, including readers of Harvard Women's Health Watch. Postmenopausal women are generally urged to get adequate calcium through diet and supplements to help protect against osteoporosis and bone fractures. Many now want to know if they should stop taking calcium supplements. The short answer is no, though you should probably get most of your calcium from foods. The BMJ study New Zealand researchers analyzed data from 11 randomized trials involving 11,921 participants who were assigned to receive either calcium supplements or a placebo for at least four years. In nine studies, the daily calcium supplement dose was 1,000 milligrams (mg) or more; in the other two, it was 500 mg and 600 mg. Overall, 2.7% of the women taking calcium supplements had heart attacks, compared with 2.2% of those taking a placebo. The difference was small in absolute terms (163 heart attacks among women taking calcium and 130 among those taking a placebo) but could be medically significant because so many people take calcium supplements. The increased risk of heart attack was greater only in supplement-takers who also consumed more than 800 mg of calcium per day through diet and thus exceeded the recommended daily amount for adults (1,000 to 1,200 mg per day). The study wasn't designed to explain how supplemental calcium might increase the risk of heart attack, but it's known that supplements raise blood levels of calcium faster, and blood calcium levels have been associated with heart attacks in observational studies. A major limitation of this study is that it excluded trials in which vitamin D was administered along with the calcium. Vitamin D is necessary for proper absorption of calcium, and guidelines on bone health recommend both calcium and vitamin D. The Annals of Internal Medicine meta-analysis that found no effect of calcium supplements on heart attack risk did consider some studies that used vitamin D supplements. In that analysis, which drew on 17 studies, the researchers also concluded that vitamin D supplements might reduce the risk of heart attacks. None of the research analyzed in the BMJ and Annals reviews was designed to study the relationship between calcium (or vitamin D) and heart attacks. This may limit the conclusions that can be drawn from the data. Calcium content of selected foods Calcium (mg) Low-fat yogurt, plain, 1 cup Food Milk, cheese, yogurt 415

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Milk, 1 cup Lactose-free milk, 1 cup Swiss cheese, 1 ounce Provolone cheese, 1 ounce Mozzarella cheese, part skim, 1 ounce Cheddar cheese, 1 ounce Parmesan cheese, grated, 2 tablespoons Frozen yogurt, 12 cup Egg, 1 large

300* 300* 224 214 207 204 111 87 58 Fortified readyto-eat cereals, 1 serving Cornbread made with lowfat milk, 1 piece Sesame paste, 2 tablespoons Almonds, 1 ounce Taco shells, 3, large Fruits, vegetables, legumes 500 20-401 261 177 163 158 80 80 70 55 25

Cereals, grains, nuts, seeds

100-1,000**

162

128

75

64

Fortified orange juice, 1 cup Soymilk, 1 cup Soybeans (edamame), 1 cup Okra, 1 cup, boiled, without salt Tofu, firm, prepared with calcium sulfate, 14 block Bok choy, 1 cup cooked Chickpeas, 1 cup White beans, 12 cup Broccoli, 1 cup, cooked Orange, 1 medium Artichoke, 1 medium

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Seafood

Salmon, sockeye, canned, 3 ounces Sardines, canned, 3 ounces *Ranges from 276 to 306 mg per cup, depending on the fat content. The more fat, the less calcium. **Check labels. Multiply the percentage figure on the package by 10. For example, if one serving supplies 40% of daily calcium, it contains 400 mg of calcium. Calcium carbonatetreated soymilk contains more digestible calcium than natural soymilk.

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What to do Recommendations for protecting bone health in postmenopausal women remain the same, and include the following: Get adequate calcium and vitamin D. If you don't supply your body with the calcium it needs, it will raid the calcium stored in your bones and sap their strength. Vitamin D is also vital to bone health because it allows calcium to pass from the intestines into the bloodstream. The National Osteoporosis Foundation (NOF) and the National Academies of Science recommend a total calcium intake (from diet and supplements) of 1,000 mg per day for women under age 50 and 1,200 mg per day for women ages 50 and over. The NOF recommends 800 to 1,000 international units (IU) of vitamin D per day, although some experts think that isn't enough. Up to 4,000 IU per day is considered safe. Though we can't draw definitive conclusions from the BMJ study, the results suggest that there may be a downside to getting our calcium mainly or exclusively from supplements. The NOF recommends using supplements only when you can't get enough from food alone. Foods contain not only vitamins and minerals but

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also hundreds of compounds that confer important health benefits and aren't included in calcium supplements or multivitamins. Also, since most people get 500 to 600 mg of calcium per day from their diet, it's unlikely that we need more than 500 to 600 mg per day of supplemental calcium. If you want to increase your dietary calcium, you have plenty of calcium-rich foods to choose from (see "Calcium content of selected foods"). Get regular weight-bearing exercise. Any exercise that involves working against gravity can help build bone. That includes jogging, walking, jumping, step aerobics, push-ups, weight lifting, resistance training with elastic bands, and stair climbing. Aim for at least 30 minutes per day. Avoid things that contribute to bone loss. Cigarette smoking promotes bone loss, as does excessive consumption of alcohol, caffeine, and vitamin A. Try to limit your daily intake to an average of one drink; three cups of coffee (or the equivalent for other caffeine sources); and no more than 700 micrograms (2,300 IU) of preformed vitamin A (most commonly listed as retinol or vitamin A palmitate). Subject: Vitamin D; Studies; Calcium; Heart attacks; Publication title: Harvard Health Publications. Harvard Women's Health Watch Publication year: 2010 Publication date: Oct 2010 Year: 2010 Publisher: Belvoir Media Group, LLC Place of publication: Boston Country of publication: United States Publication subject: Medical Sciences--Obstetrics And Gynecology, Women'S Interests ISSN: 1070910X Source type: Magazines Language of publication: English Document type: Journal Article ProQuest document ID: 1370744251 Document URL: http://search.proquest.com/docview/1370744251?accountid=50673 Copyright: Copyright 2013 by Harvard University. All rights reserved. HHP/HMS content licensing handled by Belvoir Media Group. Last updated: 2013-06-24 Database: ProQuest Medical Library

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