Calcium Supplements in Older Women Possibly Linked to More Cardiovascular Events

Blog observations about this study:

Calcium supplementation may adversely affect cardiovascular health in older women.

New Zealand researchers randomized nearly 1500 postmenopausal women to either 1 g of calcium or placebo daily; they then measured cardiovascular events over the ensuing 5 years


Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial

Mark J Bolland, research fellow1, P Alan Barber, senior lecturer1, Robert N Doughty, associate professor1, Barbara Mason, research officer1, Anne Horne, research fellow1, Ruth Ames, research officer1, Gregory D Gamble, research fellow1, Andrew Grey, associate professor1, Ian R Reid, professor1
Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
Correspondence to: I R Reid i.reid@auckland.ac.nz

Abstract

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.

Meta-Analysis of Effect of Statin Treatment on Risk of Sudden Death

Meta-Analysis of Effect of Statin Treatment on Risk of Sudden Death

Title: Meta-Analysis of Effect of Statin Treatment on Risk of Sudden Death

Topic: Arrhythmias

Date Posted: 1/11/2008

Author(s): Levatesi G, Scarano M, Marfisi R, et al.

Citation: Am J Cardiol. 2007;100:1644-1650.


Study Question: Do statins prevent sudden death (SD)?

Methods: This was a meta-analysis of 10 randomized, controlled trials in which a statin was compared with placebo or no therapy. There were a total of 22,275 patients, with 11,136 randomly assigned to receive a statin. The mean age was 60 years, 81% were male, and 69% had a history of myocardial infarction. The mean duration of follow-up was 4.4 years.

Results: The incidence of SD was significantly lower in the statin group (3.0%) than in the control group (3.8%). The 19% reduction in relative risk of SD in the statin group was independent of the extent to which the plasma cholesterol level decreased.

Conclusions: Stains reduce the relative risk of SD by approximately 20% over 4 years of follow-up.

Perspective: A reduction in SD by statins is consistent with the results of implantable cardioverter defibrillator trials that have demonstrated a reduction in the risk of appropriate shocks in patients treated with a statin. There are several possible mechanisms by which statins might reduce the risk of malignant ventricular arrhythmias, including prevention of ischemia and indirect channel effects mediated by alterations in the lipid content of cell membranes. Fred Morady, M.D., F.A.C.C.