National Osteoporosis Foundation and American Society for Preventive Cardiology Release Position Statement on Lack of Evidence Linking Calcium With or Without Vitamin D Supplementation to Cardiovascular Disease

NOF and ASPC adopt the position that at this time there is B-level or "moderate" evidence that calcium with or without vitamin D intake from food or supplements has no relationship (beneficial or detrimental) to the risk of cardiovascular and cerebrovascular disease incidence, mortality, and all-cause mortality in generally healthy adults. This official position statement has been adopted by the Boards of Directors of both societies as of July 2016 and is published in the October 25, 2016 issue of the Annals of Internal Medicine -  http://www.annals.org/article.aspx?doi=10.7326/M16-1743.

In light of the evidence available to date, calcium intake from food and supplements that does not result in an individual exceeding the 2000-2500 mg/d tolerable upper intake levels (UL), as defined by the National Academy of Medicine, should be considered safe from a cardiovascular standpoint. Obtaining calcium from food sources is preferred. Supplemental calcium can be safely used to make up any shortfalls in intake. Discontinuation of supplemental calcium for safety reasons is not necessary and may be detrimental to bone health in situations where intake from food is suboptimal. 

NOF and ASPC convened an Expert Panel to evaluate the effects on cardiovascular disease of dietary and supplemental calcium based on the existing peer-reviewed scientific literature as of July 1, 2016. The Expert Panel considered the findings of the accompanying updated Evidence Report provided by an independent Evidence Review Team at Tufts University School of Medicine.

"In our systematic review and dose-response meta-regression analysis, we sought to examine the effects of calcium intake from foods or supplements on cardiovascular disease [CVD]. We found that calcium intake levels that are within the upper limits are not associated with CVD risks among generally healthy adults but the CVD risks at very high levels of calcium intake remain unclear due to lack of data," said lead author Mei Chung, Ph.D., M.P.H., assistant professor of public health and community medicine at Tufts University School of Medicine. "Very high levels of calcium intake are impossible to achieve by dietary sources alone, such as dairy and some dark green vegetables."

Aside from the Evidence Report provided by Tufts University School of Medicine, the Expert Panel also considered a recent animal/mechanistic study, which found no detectable effect of high calcium diets (from dairy or calcium carbonate) on coronary artery calcium phosphate deposition in swine with diet-induced metabolic syndrome (5). There is currently no established biological mechanism to support an association between calcium and cardiovascular disease.

"The focus of this position statement is to provide clinicians and health professionals with an evidence-based recommendation around the health risks and benefits of calcium intake from food and/or supplements on cardiovascular and cerebrovascular disease incidence, mortality, and all-cause mortality in generally healthy adults," said Stephen L. Kopecky, MD, ASPC Board Member and member of the Expert Panel.  

"After rigorous review of all of the science currently available on calcium intake via food and supplements through July 1, 2016, we're pleased to offer this updated scientific information and guidance to healthcare professionals," said Andrea J. Singer, MD, FACP, CCD, NOF Clinical Director, Trustee and member of the Expert Panel. "Given the confusion on this topic, we felt it was very important to partner with ASPC to determine what is known at this time and how to help those who treat osteoporosis patients with recommendations for calcium and vitamin D intake."

To develop this Position Statement, NOF and ASPC adhered to the methods and processes previously published by NOF for developing Position Statements. Details can be found here: http://link.springer.com/article/10.1007%2Fs11657-016-0276-1. 

Support for the Scientific Evidence Report was provided through an unrestricted educational grant from the National Osteoporosis Foundation (NOF) through the support of Pfizer Consumer Healthcare.

About the American Society of Preventative Cardiology
The American Society for Preventive Cardiology is a national organization of healthcare providers and researchers dedicated to the prevention of atherosclerotic cardiovascular disease. The mission of the ASPC is to promote the prevention of atherosclerotic cardiovascular disease, advocate for the prevention of cardiovascular health, and disseminate high-quality, evidence-based information through education of clinicians. For more information about ASPC, visit www.aspconline.org.

About the National Osteoporosis Foundation
Established in 1984, the National Osteoporosis Foundation is the nation's leading health organization dedicated to preventing osteoporosis and broken bones, promoting strong bones for life and reducing human suffering through programs of awareness, education, advocacy and research. For more information on the National Osteoporosis Foundation, visit www.nof.org.

CONTACT:
Claire Gill, NOF
[email protected] or 703.647.3025

Stacy Manthos, ASPC
[email protected] or 904.309.6211

Siobhan E. Gallagher, Tufts
617 636 6586
[email protected]

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SOURCE National Osteoporosis Foundation

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