Calcium intake from diet and supplements and the risk of coronary artery calcification and its progression among older adults

10-year follow-up of the multi-ethnic study of atherosclerosis (MESA)

John J B Anderson, Bridget Kruszka, Joseph A C Delaney, Ka He, Gregory L. Burke, Alvaro Alonso, Diane E. Bild, Matthew Budoff, Erin Donnelly Michos

Research output: Contribution to journalArticle

Abstract

Background--Recent randomized data suggest that calcium supplements may be associated with increased risk of cardiovascular disease (CVD) events. Using a longitudinal cohort study, we assessed the association between calcium intake, from both foods and supplements, and atherosclerosis, as measured by coronary artery calcification (CAC). Methods and Results--We studied 5448 adults free of clinically diagnosed CVD (52% female; aged 45-84 years) from the Multi- Ethnic Study of Atherosclerosis. Baseline total calcium intake was assessed from diet (using a food frequency questionnaire) and calcium supplements (by a medication inventory) and categorized into quintiles. Baseline CAC was measured by computed tomography, and CAC measurements were repeated in 2742 participants ≈10 years later. At baseline, mean calcium intakes across quintiles were 313.3, 540.3, 783.0, 1168.9, and 2157.4 mg/day. Women had higher calcium intakes than men. After adjustment for potential confounders, among 1567 participants without baseline CAC, the relative risk (RR) of developing incident CAC over 10 years, by quintile 1 to 5 of calcium intake, were 1 (reference), 0.95 (0.79-1.14), 1.02 (0.85-1.23), 0.86 (0.69-1.05), and 0.73 (0.57-0.93). After accounting for total calcium intake, calcium supplement use was associated with increased risk for incident CAC (RR=1.22 [1.07-1.39]). No relation was found between baseline calcium intake and 10-year changes in logtransformed CAC among those participants with baseline CAC > 0. Conclusions--High total calcium intake was associated with a decreased risk of incident atherosclerosis over long-term followup, particularly if achieved without supplement use. However, calcium supplement use may increase the risk for incident CAC.

Original languageEnglish (US)
Article numbere003815
JournalJournal of the American Heart Association
Volume5
Issue number10
DOIs
StatePublished - 2016

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Atherosclerosis
Coronary Vessels
Diet
Calcium
Cardiovascular Diseases
Dietary Supplements
Longitudinal Studies
Cohort Studies
Tomography
Food
Equipment and Supplies

Keywords

  • Calcium
  • Cardiovascular imaging
  • Coronary artery calcium
  • Diet
  • Epidemiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Calcium intake from diet and supplements and the risk of coronary artery calcification and its progression among older adults : 10-year follow-up of the multi-ethnic study of atherosclerosis (MESA). / Anderson, John J B; Kruszka, Bridget; Delaney, Joseph A C; He, Ka; Burke, Gregory L.; Alonso, Alvaro; Bild, Diane E.; Budoff, Matthew; Michos, Erin Donnelly.

In: Journal of the American Heart Association, Vol. 5, No. 10, e003815, 2016.

Research output: Contribution to journalArticle

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title = "Calcium intake from diet and supplements and the risk of coronary artery calcification and its progression among older adults: 10-year follow-up of the multi-ethnic study of atherosclerosis (MESA)",
abstract = "Background--Recent randomized data suggest that calcium supplements may be associated with increased risk of cardiovascular disease (CVD) events. Using a longitudinal cohort study, we assessed the association between calcium intake, from both foods and supplements, and atherosclerosis, as measured by coronary artery calcification (CAC). Methods and Results--We studied 5448 adults free of clinically diagnosed CVD (52{\%} female; aged 45-84 years) from the Multi- Ethnic Study of Atherosclerosis. Baseline total calcium intake was assessed from diet (using a food frequency questionnaire) and calcium supplements (by a medication inventory) and categorized into quintiles. Baseline CAC was measured by computed tomography, and CAC measurements were repeated in 2742 participants ≈10 years later. At baseline, mean calcium intakes across quintiles were 313.3, 540.3, 783.0, 1168.9, and 2157.4 mg/day. Women had higher calcium intakes than men. After adjustment for potential confounders, among 1567 participants without baseline CAC, the relative risk (RR) of developing incident CAC over 10 years, by quintile 1 to 5 of calcium intake, were 1 (reference), 0.95 (0.79-1.14), 1.02 (0.85-1.23), 0.86 (0.69-1.05), and 0.73 (0.57-0.93). After accounting for total calcium intake, calcium supplement use was associated with increased risk for incident CAC (RR=1.22 [1.07-1.39]). No relation was found between baseline calcium intake and 10-year changes in logtransformed CAC among those participants with baseline CAC > 0. Conclusions--High total calcium intake was associated with a decreased risk of incident atherosclerosis over long-term followup, particularly if achieved without supplement use. However, calcium supplement use may increase the risk for incident CAC.",
keywords = "Calcium, Cardiovascular imaging, Coronary artery calcium, Diet, Epidemiology",
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T2 - 10-year follow-up of the multi-ethnic study of atherosclerosis (MESA)

AU - Anderson, John J B

AU - Kruszka, Bridget

AU - Delaney, Joseph A C

AU - He, Ka

AU - Burke, Gregory L.

AU - Alonso, Alvaro

AU - Bild, Diane E.

AU - Budoff, Matthew

AU - Michos, Erin Donnelly

PY - 2016

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N2 - Background--Recent randomized data suggest that calcium supplements may be associated with increased risk of cardiovascular disease (CVD) events. Using a longitudinal cohort study, we assessed the association between calcium intake, from both foods and supplements, and atherosclerosis, as measured by coronary artery calcification (CAC). Methods and Results--We studied 5448 adults free of clinically diagnosed CVD (52% female; aged 45-84 years) from the Multi- Ethnic Study of Atherosclerosis. Baseline total calcium intake was assessed from diet (using a food frequency questionnaire) and calcium supplements (by a medication inventory) and categorized into quintiles. Baseline CAC was measured by computed tomography, and CAC measurements were repeated in 2742 participants ≈10 years later. At baseline, mean calcium intakes across quintiles were 313.3, 540.3, 783.0, 1168.9, and 2157.4 mg/day. Women had higher calcium intakes than men. After adjustment for potential confounders, among 1567 participants without baseline CAC, the relative risk (RR) of developing incident CAC over 10 years, by quintile 1 to 5 of calcium intake, were 1 (reference), 0.95 (0.79-1.14), 1.02 (0.85-1.23), 0.86 (0.69-1.05), and 0.73 (0.57-0.93). After accounting for total calcium intake, calcium supplement use was associated with increased risk for incident CAC (RR=1.22 [1.07-1.39]). No relation was found between baseline calcium intake and 10-year changes in logtransformed CAC among those participants with baseline CAC > 0. Conclusions--High total calcium intake was associated with a decreased risk of incident atherosclerosis over long-term followup, particularly if achieved without supplement use. However, calcium supplement use may increase the risk for incident CAC.

AB - Background--Recent randomized data suggest that calcium supplements may be associated with increased risk of cardiovascular disease (CVD) events. Using a longitudinal cohort study, we assessed the association between calcium intake, from both foods and supplements, and atherosclerosis, as measured by coronary artery calcification (CAC). Methods and Results--We studied 5448 adults free of clinically diagnosed CVD (52% female; aged 45-84 years) from the Multi- Ethnic Study of Atherosclerosis. Baseline total calcium intake was assessed from diet (using a food frequency questionnaire) and calcium supplements (by a medication inventory) and categorized into quintiles. Baseline CAC was measured by computed tomography, and CAC measurements were repeated in 2742 participants ≈10 years later. At baseline, mean calcium intakes across quintiles were 313.3, 540.3, 783.0, 1168.9, and 2157.4 mg/day. Women had higher calcium intakes than men. After adjustment for potential confounders, among 1567 participants without baseline CAC, the relative risk (RR) of developing incident CAC over 10 years, by quintile 1 to 5 of calcium intake, were 1 (reference), 0.95 (0.79-1.14), 1.02 (0.85-1.23), 0.86 (0.69-1.05), and 0.73 (0.57-0.93). After accounting for total calcium intake, calcium supplement use was associated with increased risk for incident CAC (RR=1.22 [1.07-1.39]). No relation was found between baseline calcium intake and 10-year changes in logtransformed CAC among those participants with baseline CAC > 0. Conclusions--High total calcium intake was associated with a decreased risk of incident atherosclerosis over long-term followup, particularly if achieved without supplement use. However, calcium supplement use may increase the risk for incident CAC.

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KW - Epidemiology

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