title: Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study.
abstract: OBJECTIVE
  To investigate the association between long term intake of dietary and supplemental calcium and death from all causes and cardiovascular disease.
  
  
  METHODS
  Prospective longitudinal cohort study.
  
  
  METHODS
  Swedish mammography cohort, a population based cohort established in 1987-90.
  
  
  METHODS
  61 433 women (born between 1914 and 1948) followed-up for a median of 19 years.
  
  
  METHODS
  Primary outcome measures, identified from registry data, were time to death from all causes (n=11 944) and cause specific cardiovascular disease (n=3862), ischaemic heart disease (n=1932), and stroke (n=1100). Diet was assessed by food frequency questionnaires at baseline and in 1997 for 38 984 women, and intakes of calcium were estimated. Total calcium intake was the sum of dietary and supplemental calcium.
  
  
  RESULTS
  The risk patterns with dietary calcium intake were non-linear, with higher rates concentrated around the highest intakes (≥1400 mg/day). Compared with intakes between 600 and 1000 mg/day, intakes above 1400 mg/day were associated with higher death rates from all causes (hazard ratio 1.40, 95% confidence interval 1.17 to 1.67), cardiovascular disease (1 49, 1.09 to 2.02), and ischaemic heart disease (2.14, 1.48 to 3.09) but not from stroke (0.73, 0.33 to 1.65). After sensitivity analysis including marginal structural models, the higher death rate with low dietary calcium intake (<600 mg/day) or with low and high total calcium intake was no longer apparent. Use of calcium tablets (6% users; 500 mg calcium per tablet) was not on average associated with all cause or cause specific mortality but among calcium tablet users with a dietary calcium intake above 1400 mg/day the hazard ratio for all cause mortality was 2.57 (95% confidence interval 1.19 to 5.55).
  
  
  CONCLUSIONS
  High intakes of calcium in women are associated with higher death rates from all causes and cardiovascular disease but not from stroke.
authors: Department of Surgical Sciences, Section of Orthopedics, Uppsala University, SE-751 85 Uppsala, Sweden. karl.michaelsson@surgsci.uu.se
authors: Karl
authors: K
authors: Michaëlsson
authors: Håkan
authors: H
authors: Melhus
authors: Eva
authors: E
authors: Warensjö Lemming
authors: Alicja
authors: A
authors: Wolk
authors: Liisa
authors: L
authors: Byberg
mesh_terms: D000328:Adult; D000368:Aged; D002136:Calcium, Dietary / Q000008:administration & dosage / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology
chemical_list: D002136:Calcium, Dietary
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