Both dietary and supplemental calcium should be considered safe for the cardiovascular system as long as total intake doesn’t exceed 2,000-2,500 mg/day – the maximal tolerable level defined by the National Academy of Medicine, according to an updated Clinical Practice Guideline published online October 24 in Annals of Internal Medicine.
For generally healthy patients who don’t consume adequate calcium and take supplements, either alone or in combination with vitamin D, to prevent osteoporosis and related fractures, “discontinuation of supplemental calcium for safety reasons is not necessary and may be harmful to bone health,” said Stephen L. Kopecky, MD, of the Mayo Clinic, Rochester Minn., and his associates on the expert panel that wrote the new guideline.
©iStock/ThinkStockPhotos.com
The National Osteoporosis Foundation (NOF) and the American Society for Preventive Cardiology (ASPC) commissioned an independent review of the current evidence to update the Evidence Report and assembled the expert panel to write the guideline based on the new findings (Ann Intern Med. 2016 Oct 24. doi: 10.7326/M16-1743).
Separately, Mei Chung, PhD, of the department of public health and community medicine, and her associates at Tufts University, Boston, reviewed 4 recent randomized clinical trials, 1 nested case-control study, and 26 cohort studies that assessed the effects of calcium intake on 17 health outcomes in generally healthy adults of all ages. None of the studies evaluated cardiovascular disease risk as a primary outcome. “We conclude that calcium intake (from either food or supplement sources) at levels within the recommended tolerable upper intake range (2,000-2,500 mg/d) are not associated with CVD risks in generally healthy adults,” they said.
“Although a few trials and cohort studies reported increased risks with higher calcium intake, risk estimates in most of those studies were small (10% relative risk) and not considered clinically important, even if they were statistically significant,” Dr. Chung and her associates added (Ann Int Med. 2016 Oct 24. doi: 10.7326/M16-1165).
According to the guideline, “The NOF and the ASPC now adopt the position that there is moderate-quality evidence that calcium with or without vitamin D intake from food or supplements has no relationship (beneficial or harmful) with the risk for cardiovascular or cerebrovascular disease, mortality, or all-cause mortality in generally healthy adults at this time.”
In addition, “Currently, no established biological mechanism supports and association between calcium and cardiovascular disease,” Dr. Kopecky and his associates on the expert panel noted.