title: Cross-sectional analysis of calcium intake for associations with vascular calcification and mortality in individuals with type 2 diabetes from the Diabetes Heart Study.
abstract: BACKGROUND
  The use of calcium supplements to prevent declines in bone mineral density and fractures is widespread in the United States, and thus reports of elevated cardiovascular disease (CVD) risk in users of calcium supplements are a major public health concern. Any elevation in CVD risk with calcium supplement use would be of particular concern in individuals with type 2 diabetes (T2D) because of increased risks of CVD and fractures observed in this population.
  
  
  OBJECTIVE
  In this study, we examined associations between calcium intake from diet and supplements and measures of subclinical CVD (calcified plaque in the coronary artery, carotid artery, and abdominal aorta) and mortality in individuals affected by T2D.
  
  
  METHODS
  We performed a cross-sectional analysis in individuals affected by T2D from the family-based Diabetes Heart Study (n = 720).
  
  
  RESULTS
  We observed no significant associations of calcium from diet or supplements with any of our measures of calcified plaque, and no greater mortality risk was observed with increased calcium intake. Instead, calcium supplement use was modestly associated with reduced all-cause mortality in women (HR: 0.62; 95% CI: 0.42, 0.92; P = 0.017).
  
  
  CONCLUSIONS
  Our results do not support a substantial association between calcium intake from diet or supplements and CVD risk in individuals with T2D.
authors.affiliation: From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC).
authors.forename: Laura M
authors.initials: LM
authors.lastname: Raffield
authors.affiliation: From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC).
authors.forename: Subhashish
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC).
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cox
authors.affiliation: From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC).
authors.forename: Fang-Chi
authors.initials: FC
authors.lastname: Hsu
authors.affiliation: From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC).
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC).
authors.forename: Barry I
authors.initials: BI
authors.lastname: Freedman
authors.affiliation: From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC).
authors.forename: Jianzhao
authors.initials: J
authors.lastname: Xu
authors.affiliation: From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC).
authors.forename: Donald W
authors.initials: DW
authors.lastname: Bowden
authors.affiliation: From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC).
authors.forename: Mara Z
authors.initials: MZ
authors.lastname: Vitolins
mesh_terms: D002136:Calcium, Dietary / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D061205:Vascular Calcification / Q000150:complications / Q000453:epidemiology* / Q000401:mortality
chemical_list: D002136:Calcium, Dietary
references.citation: Am J Epidemiol. 2007 Sep 1;166(5):495-505
references.pmid: 17575306
references.citation: N Engl J Med. 2008 Mar 27;358(13):1336-45
references.pmid: 18367736
references.citation: Arch Intern Med. 2008 Jun 23;168(12):1333-9
references.pmid: 18574091
references.citation: J Bone Miner Res. 2010 Dec;25(12):2777-85
references.pmid: 20641031
references.citation: Bone. 2006 Sep;39(3):628-33
references.pmid: 16690365
references.citation: Heart. 2012 Jun;98(12):920-5
references.pmid: 22626900
references.citation: Stroke. 2002 Jul;33(7):1876-81
references.pmid: 12105369
references.citation: JAMA. 2010 Apr 28;303(16):1610-6
references.pmid: 20424251
references.citation: Osteoporos Int. 2007 Apr;18(4):427-44
references.pmid: 17068657
references.citation: Am J Clin Nutr. 1997 Apr;65(4 Suppl):1220S-1228S; discussion 1229S-1231S
references.pmid: 9094926
references.citation: Diabetes Care. 2011 May;34(5):1219-24
references.pmid: 21398528
references.citation: J Clin Epidemiol. 1990;43(12):1327-35
references.pmid: 2254769
references.citation: J Am Coll Cardiol. 2010 Oct 19;56(17):1397-406
references.pmid: 20946997
references.citation: Arterioscler Thromb Vasc Biol. 2010 Nov;30(11):2289-96
references.pmid: 20814018
references.citation: J Am Coll Cardiol. 2004 May 5;43(9):1663-9
references.pmid: 15120828
references.citation: JAMA Intern Med. 2013 Apr 22;173(8):639-46
references.pmid: 23381719
references.citation: Am J Clin Nutr. 2012 Dec;96(6):1274-80
references.pmid: 23134889
references.citation: Diabetes. 2001 Apr;50(4):861-6
references.pmid: 11289053
references.citation: Arch Intern Med. 2011 Oct 10;171(18):1625-33
references.pmid: 21987192
references.citation: Diabetes. 2006 Jul;55(7):1985-94
references.pmid: 16804067
references.citation: Osteoporos Int. 2011 Dec;22(12):3073-7
references.pmid: 21633827
references.citation: Circulation. 2010 Feb 23;121(7):e46-e215
references.pmid: 20019324
references.citation: J Am Coll Cardiol. 2010 Oct 19;56(17):1407-14
references.pmid: 20946998
references.citation: Br J Nutr. 2004 Apr;91(4):617-23
references.pmid: 15035689
references.citation: BMJ. 2011 Apr 19;342:d2040
references.pmid: 21505219
references.citation: Ann Intern Med. 2010 Mar 2;152(5):315-23
references.pmid: 20194238
references.citation: Am J Epidemiol. 2003 May 15;157(10):888-97
references.pmid: 12746241
references.citation: BMJ. 2008 Feb 2;336(7638):262-6
references.pmid: 18198394
references.citation: Nat Rev Endocrinol. 2012 Sep;8(9):529-43
references.pmid: 22473330
references.citation: Menopause. 2010 Jul;17(4):683-91
references.pmid: 20551849
references.citation: BMJ. 2010 Jul 29;341:c3691
references.pmid: 20671013
references.citation: Am J Med. 2011 Dec;124(12):1097-8
references.pmid: 21798509
references.citation: Am J Epidemiol. 2007 Aug 1;166(3):340-7
references.pmid: 17493948
references.citation: Eur J Epidemiol. 2012 May;27(5):319-32
references.pmid: 22451239
references.citation: Rev Diabet Stud. 2010 Fall;7(3):188-201
references.pmid: 21409311
references.citation: J Am Coll Cardiol. 2003 Mar 19;41(6):1008-12
references.pmid: 12651050
references.citation: Diabetes Care. 2013 Apr;36(4):972-7
references.pmid: 23230101
references.citation: AJR Am J Roentgenol. 2000 Apr;174(4):915-21
references.pmid: 10749222
references.citation: Radiology. 2005 Jan;234(1):35-43
references.pmid: 15618373
references.citation: NCHS Data Brief. 2011 Apr;(61):1-8
references.pmid: 21592424
references.citation: Osteoporos Int. 2013 Feb;24(2):567-80
references.pmid: 23208074
references.citation: J Clin Endocrinol Metab. 2013 Jul;98(7):3010-8
references.pmid: 23703722