Vascular events in healthy older women receiving calcium
supplementation: randomised controlled trial
Mark J Bolland, research fellow1, P Alan Barber, senior
lecturer, Robert N Doughty, associate professor, Barbara
Mason, research officer, Anne Horne, research fellow,
Ruth Ames, research officer, Gregory D Gamble, research
fellow, Andrew Grey, associate professor, Ian R Reid,
professor
Department of Medicine, Faculty of Medical and Health
Sciences, University of Auckland, Private Bag 92019,
Auckland, New Zealand
OBJECTIVE: To determine the effect of calcium
supplementation on myocardial infarction, stroke,
and sudden death in healthy postmenopausal women.
DESIGN: Randomised, placebo controlled trial.
SETTING: Academic medical centre in an urban setting
in New Zealand.
PARTICIPANTS: 1471 postmenopausal women (mean age 74):
732 were randomised to calcium supplementation and 739
to placebo.
MAIN OUTCOME MEASURES: Adverse cardiovascular events
over five years: death, sudden death, myocardial
infarction, angina, other chest pain, stroke,
transient ischaemic attack, and a composite end point
of myocardial infarction, stroke, or sudden death.
RESULTS: Myocardial infarction was more commonly
reported in the calcium group than in the placebo
group (45 events in 31 women v 19 events in 14 women,
P=0.01). The composite end point of myocardial
infarction, stroke, or sudden death was also more
common in the calcium group (101 events in 69 women
v 54 events in 42 women, P=0.008). After adjudication
myocardial infarction remained more common in the
calcium group (24 events in 21 women v 10 events
in 10 women, relative risk 2.12, 95% confidence
interval 1.01 to 4.47). For the composite end point
61 events were verified in 51 women in the calcium
group and 36 events in 35 women in the placebo group
(relative risk 1.47, 0.97 to 2.23). When unreported
events were added from the national database of
hospital admissions in New Zealand the relative risk
of myocardial infarction was 1.49 (0.86 to 2.57) and
that of the composite end point was 1.21 (0.84 to
1.74). The respective rate ratios were 1.67 (95%
confidence intervals 0.98 to 2.87) and 1.43 (1.01 to
2.04); event rates: placebo 16.3/1000 person years,
calcium 23.3/1000 person years. For stroke
(including unreported events) the relative risk
was 1.37 (0.83 to 2.28) and the rate ratio was 1.45
(0.88 to 2.49).
CONCLUSION: Calcium supplementation in healthy
postmenopausal women is associated with upward
trends in cardiovascular event rates. This
potentially detrimental effect should be balanced
against the likely benefits of calcium on bone.
This topic needs some balance
>
> CONCLUSION: Calcium supplementation in healthy
> postmenopausal women is associated with upward
> trends in cardiovascular event rates. This
> potentially detrimental effect should be balanced
> against the likely benefits of calcium on bone.
FROM SAME STUDY
Because of the high incidence of vascular disease in postmenopausal
women any effects of calcium supplements on vascular health could be
as important in terms of their effects on morbidity and mortality as
their effects on bone. Although no randomised controlled trials have
been designed primarily to assess the effect of calcium
supplementation on vascular event rates or deaths, secondary analyses
of the women's health initiative study have recently shown no
consistent effects in a population of average age 62.......
.......The present study has several limitations, principally its
small size for a study with cardiovascular end points. The cohort
comprised elderly (10% aged more than 80 at baseline) and white
participants, so the findings are not necessarily generalisable to
other ages and racial groups.
..........A much larger randomised controlled trial of the effect of
calcium carbonate and vitamin D supplementation has recently been
published by the women's health initiative investigators.14 This study
of 36 000 women, followed over seven years, showed no overall effect
of the supplements on cardiovascular event rates
.......The data on vascular events from a secondary, preplanned
analysis of the Auckland calcium study are not conclusive but suggest
that high calcium intakes might have an adverse effect on vascular
health. The similarities between these findings and those from the
dialysis literature suggest that this might be a particular concern in
those with poor renal function, particularly elderly people. The
subgroup analyses available within the women's health initiative would
be consistent with this hypothesis......
Thanks Vince
I believe that if calcium is not given with magnesium in the correct 3:1
ratio, and if either excessive or even inadequate vitamin D levels are not
maintained, then there is the possiblity of calicium plaques developing
within arteries. However, the risk:benefit trade-off of calcium
supplemenatation favors the prevention and treatment of osteopoorosis, which
has a significant mortality of its own.
This is more proof that we cannot grind rock to a powder and expect
our bodies to absorb and use it properly.
CaC03 is limestone. Why in the world should we believe that all we
need to do is suck, or chew, on limestone to get our calcium needs
met? Most likely, if it is even absorbed , it will precipitate other
problems like calcification of our arteries, hardening of the skin and
the setting of wrinkles, or brain disorders.
Humans need ORGANIC calcium, not INORGANIC calcium to meet their
biological needs. When will the docs and the pharma flacks ever
realize this and even admit it?
DrCee
perhaps a deficient component is actually Mg?
"Mark Thorson" <nos...@sonic.net> wrote '
> Quoting from:
> http://www.bmj.com/cgi/content/full/bmj.39440.525752.BEv1
[...]
There are 12 essential cellsalts including calcium.
If a person takes calcium only, their system gets out of balance.
Carole
www.cellsalts.net
> CaC03 is limestone. Why in the world should we believe that all we
> need to do is suck, or chew, on limestone to get our calcium needs
> met? Most likely, if it is even absorbed , it will precipitate other
> problems like calcification of our arteries, hardening of the skin and
> the setting of wrinkles, or brain disorders.
>
> Humans need ORGANIC calcium, not INORGANIC calcium to meet their
> biological needs. When will the docs and the pharma flacks ever
> realize this and even admit it?
And you would propose to use -- which -- form of calcium?
(Yes, it's a trick question.)
--
| Bogus as it might seem, people, this really is a deliverable |
| e-mail address. Of course, there isn't REALLY a lumber cartel. |
| There isn't really a Santa Claus, but try www.santaclaus.com. |
+--------------- D. C. Sessions <d...@lumbercartel.com> --------------+
> And you would propose to use -- which -- form of calcium?
> (Yes, it's a trick question.)
Looking at Drcee's website, I found the following:
"The Coleman Health and Lifestyle Center is a non-profit, religious
organization which seeks to provide the reader with the knowledge that
the CREATOR has provided TWO sets of laws governing our actions on
this earth. One set of laws are concerned with the CREATOR while the
second set (the natural laws) governs all that happens upon this
Earth. We seek to provide data, information, and understanding of the
NATURAL LAWS that govern our existence."
--
Ron
>
> DrCee
First, limestone by way of hard water is an ancient calcium
source. Second, since the invention of grain flour and the
use of limestone grindstones, calcium carbonate has
been added directly to a foods stuff even if unintentionally.
The problem with this study is that the subjects
were almost certainly standard diets which a pitifully
low in vitamin K even diet consider OK by dieticians
are too low in vitamin K. Further most populations
have periods of the year in which they have
elevate PTH levels due to either vitamin D deficiency
or insufficiency. Plus many people have low dietary
intakes of magnesium as well.
Perhaps Mark Thorsen wants to join the MILK KILLs Crowd???
Remember Mark, hip fractures and bone breaks kill
elderly indirectly all the time. Indeed the bisphosphonate
have adverse effects that can cripple or even kill.
There is an issue of risk versus reward in all choices.
I won't get overly worried about calcium carbonate,
rather I suggest people take generous amounts
of vitamin K and vitamin D3. It is quite true calcium
supplement are over emphasized by the medical
community. A more alkaline diet lower in meat and
grain certainly has merits in preventling osteoporosis.
And a diet somewhat lower in calcium has the merits
of pushing the kidneys to activate more 25 OH vitamin D
into 1, 25 OH2 vitamin D which should help slow and prevent
various cancers as well as increasing calcium uptake
out of the GI tract.
In short, people need far more green leafy vegetables,
more fruit, only limited amounts of whole grains,
modest amounts of range fed meat, and so on.
And if one is aggressive and up on the science a good
dose of of vitamin K and vitamin D3 by way of supplements
are likely would be good for the bulk of the population
here in the "First World.".
> First, limestone by way of hard water is an ancient calcium
> source. Second, since the invention of grain flour and the
> use of limestone grindstones, calcium carbonate has
> been added directly to a foods stuff even if unintentionally.
What's best is that Cee's rant proves that he didn't bother to
Read The Fine Article before launching the diatribe.
Homeopathy treats rickets with traces of
calcium phosphate and calcium fluoride
not what is really needed which is vitamin D
or sunlight. Check what the homeopathy handbook
suggests as a treatment.
More likely a matter of making sure there's enough of both and not
too much of either. Excess Mg is more readily excreted than
excess Ca, so the exact amount of Mg in particular isn't all that
critical.
It's not like natural foods have precise ratios, after all -- animals
have to be pretty flexible about such things and have mechanisms to
manage the variations.
> The problem with this study is that the subjects
> were almost certainly standard diets which a pitifully
> low in vitamin K even diet consider OK by dieticians
> are too low in vitamin K.
Since K is produced by intestinal flora, dietary amounts
aren't any more critical than looking to the dietary
ascorbate in canines.
> Further most populations
> have periods of the year in which they have
> elevate PTH levels due to either vitamin D deficiency
> or insufficiency. Plus many people have low dietary
> intakes of magnesium as well.
The study observes up front that it is limited in that it
only looks to calcium supplementation.
> Remember Mark, hip fractures and bone breaks kill
> elderly indirectly all the time. Indeed the bisphosphonate
> have adverse effects that can cripple or even kill.
> There is an issue of risk versus reward in all choices.
The study admits up front that it is limited by only considering
cardiac outcomes.
> In short, people need far more green leafy vegetables,
> more fruit, only limited amounts of whole grains,
> modest amounts of range fed meat, and so on.
Watch out -- you're vergeing dangerously close to "Evil Orthodox
Medicine" here.
DrCee,
You are correct that calcium carbonate is one of the worst forms of
calcium supplementation. However, more to the point, this article is
a perfect example of junk science. I just read the entire article,
not just the abstract, and the authors made no measurements of serum
levels of calcium before or after supplementation. Since elderly
people have low levels of stomach acid, and calcium carbonate
increases pH, it is possible that some of the participants might have
ended up with lower levels of serum calcium as a result of ingesting
the calcium carbonate. In any case, there is no excuse for such
sloppy experimental protocols.
Ed Friedman
And you may want to lookup the
disassociation constant for calcium citrate.
And then you need ask yourself why
this is important.
See the following cut and paste on
the topic.
Calcium Supplements May Increase MI Risk in Older Women
BMJ Online First, January 16, 2008, as reported by WebMD
Healthy postmenopausal women randomly assigned to receive 1 g of
elemental calcium citrate supplements daily for 5 years had a more
than 2-fold greater relative risk for myocardial infarction (MI)
compared with women receiving placebo, reports WebMD. Calcium takers
were also at greater risk for a composite cardiovascular event
endpoint of MI, stroke,
or sudden death. The investigators, from the University of Auckland,
New Zealand, concluded that the potential benefits of calcium
supplementation for preservation of skeletal health may not outweigh
the detrimental cardiovascular events in this population.
Thanks for setting us straight Ed.
(Wot?! Mark Thorson posting junk science!?
Scaring the bejesus out of people, screaming bloody murder.
what a hypocrite! who woulda thunk? :(
> Since elderly
> people have low levels of stomach acid, and calcium carbonate
> increases pH, it is possible that some of the participants might have
> ended up with lower levels of serum calcium as a result of ingesting
> the calcium carbonate.
That's a plausible explanation for calcium carbonate causing adverse
cardiac outcomes. Or it would be, except that the chemistry doesn't
work that way. However, granting that the higher stomach pH might
have adverse effects your speculation is interesting.
Of course, that doesn't explain what your speculation has to do with
this study.
> Are you saying calcium citrate is inorganic?
Dang. You gave it away.
D.C.,
I'm not sure what you mean that "the chemistry doesn't work that
way". If you check out Annals of Internal Medicine, 1967, 66:917-923,
"The absorption of calcium carbonate", you will see that only 2% of
the calcium from calcium carbonate is absorbed when stomach pH is
6.5. The absorption increases as pH drops. In the article in
question, they did not even list the specific source of calcium used
for supplementation, but they did talk about another article that used
calcium carbonate.
Ed Friedman
Generally, if you were to spend the time to actually read these
totally bogus research studies they are extremely likely to be doing
something totally stupid, such as you have suggested above.
These people are bigoted, plain and simple. Totally devoid of any
research ethics, they will stoop to any low-level to prove that taking
supplements is dangerous.
And w know this -- how?
Why, by doing exactly what this study did: supplement calcium alone.
Now someone else can do a study with Ca+Mg (or various ratios thereof)
and prove exactly what you're telling us. That way, when someone like
me asks "how do you know that the correct ratio is 3:1 instead of 2:1?"
you can point him to blinded, controlled studies instead of an opinion
piece disagreeing with another opinion piece.
> These people are bigoted, plain and simple. Totally devoid of any
> research ethics, they will stoop to any low-level to prove that taking
> supplements is dangerous.
My, aren't you charitable today towards someone who actually went to the
trouble of publishing work that supports your beliefs!
Prior experience and a superior brain. :)
> Why, by doing exactly what this study did: supplement calcium alone.
> Now someone else can do a study with Ca+Mg (or various ratios thereof)
> and prove exactly what you're telling us. That way, when someone like
> me asks "how do you know that the correct ratio is 3:1 instead of 2:1?"
> you can point him to blinded, controlled studies instead of an opinion
> piece disagreeing with another opinion piece.
>
> > These people are bigoted, plain and simple. Totally devoid of any
> > research ethics, they will stoop to any low-level to prove that taking
> > supplements is dangerous.
>
> My, aren't you charitable today towards someone who actually went to the
> trouble of publishing work that supports your beliefs!
>
Another instance of medical scientism caught scamming the government
trough out of money for totally unnecessary research.
http://naturalhealthperspective.com/gnu-dictionary/medical-scientism.html
" There are 12 essential cellsalts including calcium. If a person takes
calcium only, their system gets out of balance. "
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
Edgar Cayce, the 'Sleeping Prophet' recommended boiling Potato Skins
to get/release it's beneficial salts.
Most of his prescriptions were run-of-the-mill for quackery
of the day, which would have been known to his osteopath
friend Laney, who conducted the Cayce "readings". Some of
his prescriptions were just plain stupid, like eating
Jerusalem artichokes for diabetes. In a reading, Cayce
said they contain "insulin". The entity Cayce was
channeling must have had a reading comprehension problem,
because there's no "insulin" in Jerusalem artichokes,
but a significant amount of "inulin".
There's also Cayce's predictions concerning certain
geological events that were supposed to occur in the
1960's and 1970's? Such as the western part of North America
being submerged under the Pacific Ocean? Northern Europe
disappearing "in the twinkling of an eye". Atlantis rising
from the ocean? I'm still waiting.....
In fact, Cayce predicted his own reincarnation, around the
turn of the century (i.e. a few years ago). He would be
reincarnated in a town along the Pacific coast.... of Nebraska!
For more information, I recommend reading EDGAR CAYCE ON ATLANTIS,
written by his son Hugh Lynn Cayce. I wonder what that guy does
for a living these days? Does the A.R.E. receive enough donations
to support him?
> In message <4f34507f-3211-43ef...@e6g2000prf.googlegroups.com>, drce...@insightbb.com wrote:
>
>> CaC03 is limestone. Why in the world should we believe that all we
>> need to do is suck, or chew, on limestone to get our calcium needs
>> met? Most likely, if it is even absorbed , it will precipitate other
>> problems like calcification of our arteries, hardening of the skin and
>> the setting of wrinkles, or brain disorders.
>>
>> Humans need ORGANIC calcium, not INORGANIC calcium to meet their
>> biological needs. When will the docs and the pharma flacks ever
>> realize this and even admit it?
>
> And you would propose to use -- which -- form of calcium?
>
> (Yes, it's a trick question.)
Which, to nobody's surprise, Cee ran from answering.
Hardly surprising in someone who not only rants about a study
without bothering to read the linked article but also can't
tell the difference between metallic calcium and bioavailable
calcium salts.
" Most of his prescriptions were run-of-the-mill for quackery of the
day, which would have been known to his osteopath friend Laney, who
conducted the Cayce "readings". Some of his prescriptions were just
plain stupid, like eating Jerusalem artichokes for diabetes. In a
reading, Cayce said they contain "insulin". The entity Cayce was
channeling must have had a reading comprehension problem, because
there's no "insulin" in Jerusalem artichokes, but a significant amount
of "inulin".
There's also Cayce's predictions concerning certain geological events
that were supposed to occur in the 1960's and 1970's? Such as the
western part of North America being submerged under the Pacific Ocean?
Northern Europe disappearing "in the twinkling of an eye". Atlantis
rising from the ocean? I'm still waiting.....
In fact, Cayce predicted his own reincarnation, around the turn of the
century (i.e. a few years ago). He would be reincarnated in a town along
the Pacific coast.... of Nebraska!
For more information, I recommend reading EDGAR CAYCE ON ATLANTIS,
written by his son Hugh Lynn Cayce. I wonder what that guy does for a
living these days? Does the A.R.E. receive enough donations to support
him? "
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
I just mentioned the Edgar Cayce advice
in passing, I don't know if it has any basis
in fact.