title: Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg).
abstract: BACKGROUND
  It has been suggested that a higher calcium intake might favourably modify cardiovascular risk factors. However, findings of an ultimately decreased risk of cardiovascular disease (CVD) are limited. Instead, recent evidence warns that taking calcium supplements might increase myocardial infarction (MI) risk.
  
  
  OBJECTIVE
  To prospectively evaluate the associations of dietary calcium intake and calcium supplementation with MI and stroke risk and overall CVD mortality.
  
  
  METHODS
  Data from 23 980 Heidelberg cohort participants of the European Prospective Investigation into Cancer and Nutrition study, aged 35-64 years and free of major CVD events at recruitment, were analysed. Multivariate Cox regression models were used to estimate HRs and 95% CIs.
  
  
  RESULTS
  After an average follow-up time of 11 years, 354 MI and 260 stroke cases and 267 CVD deaths were documented. Compared with the lowest quartile, the third quartile of total dietary and dairy calcium intake had a significantly reduced MI risk, with a HR of 0.69 (95% CI 0.50 to 0.94) and 0.68 (95% CI 0.50 to 0.93), respectively. Associations for stroke risk and CVD mortality were overall null. In comparison with non-users of any supplements, users of calcium supplements had a statistically significantly increased MI risk (HR=1.86; 95% CI 1.17 to 2.96), which was more pronounced for calcium supplement only users (HR=2.39; 95% CI 1.12 to 5.12).
  
  
  CONCLUSIONS
  Increasing calcium intake from diet might not confer significant cardiovascular benefits, while calcium supplements, which might raise MI risk, should be taken with caution.
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany.
authors.forename: Kuanrong
authors.initials: K
authors.lastname: Li
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Jakob
authors.initials: J
authors.lastname: Linseisen
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
mesh_terms: D000328:Adult; D000493:Allopurinol; D002118:Calcium / Q000378:metabolism*; D002136:Calcium, Dietary / Q000009:adverse effects* / Q000627:therapeutic use; D019587:Dietary Supplements / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality*; D009749:Nutrition Surveys / Q000379:methods*; D010024:Osteoporosis / Q000378:metabolism / Q000517:prevention & control; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate / Q000639:trends
chemical_list: D002136:Calcium, Dietary; D000493:Allopurinol; D002118:Calcium