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Calcium supplements linked to harm in people with aortic stenosis

Reuters Health - 26/04/2022 - A large observational study suggests a need to rethink calcium supplements in people with aortic stenosis.

The study of elderly patients with initially mild to moderate AS followed for more than five years found that supplemental calcium, with or without vitamin D, was associated with significantly lower survival and greater need for aortic-valve replacement (AVR).

"Our findings suggest that supplemental calcium in this population does not confer any cardiovascular benefit, and instead these relationships should be thoughtfully considered in light of growing evidence and concern for CV harm particularly with unnecessary supplementation," write Dr. Samir Kapadia and colleagues with the Cleveland Clinic Ohio in the journal Heart.

Their findings are based on 2,657 patients (mean age, 74 years; 42% women) with mild to moderate native AS.

Nearly half (49%) were not taking any supplements, 12% took vitamin D alone and 39% took calcium with or without vitamin D (11% of this group took vitamin D alone).

During median follow-up of close to six years, 21% participants died and 29% had their aortic-valve replaced.

Taking vitamin D alone didn't seem to affect survival. However, supplemental calcium plus vitamin D was associated with a significantly higher risk of dying from any cause (hazard ratio, 1.31; 95% CI, 1.07 to 1.62) and a doubling of the risk of dying from cardiovascular disease (HR, 2.0; 95% CI, 1.31 to 3.07).

Calcium with vitamin D was also associated with a higher risk of AVR (HR, 1.48; 95% CI: 1.24 to 1.78; P<0.001), compared with no supplement use.

Taking only calcium supplements was associated with a numerically higher risk of dying from any cause (HR, 1.24; 95% CI, 0.77 to 1.99) and a near tripling in the risk of AVR (HR, 2.7; 95% CI, 1.76 to 4.08).

Dr. Kapadia and colleagues caution that their study can't establish cause, and that those taking supplements had more risk factors for heart disease and death than those who weren't, and the amount of calcium intake from diet and supplements were not assessed.

Nevertheless, they say, "Strengthened by its large sample size and extended follow-up period, our study suggests that calcium supplementation does not confer any cardiovascular benefit, and instead may reflect an elevated overall risk of AVR and mortality, especially in those not undergoing AVR."

"Importantly, in the present study in AS, the mortality increase with calcium supplementation persisted in women or men, and was independent of the osteoporosis status at entry," Dr. Jutta Bergler-Klein of the Medical University of Vienna, Austria, notes in a linked editorial.

"Intuitively, one might think that supplementing vitamins and minerals would be the right thing to do especially in older and comorbid people. Every year, billions of dollars are spent in this belief. However, we may all be wrong," she points out.

Dr. Bergler-Klein says "the safety of artificial supplementary calcium intake has to be considered in an individual and careful view. Evaluation of underlying CVD and risk factors such as lipids, smoking, hypertension or concomitant kidney disease should be taken into account of the overall clinical situation of the patient if osteoporosis treatment or prevention is aimed for."

In patients with calcific AS and high-risk heart disease, the present study "strongly adds to the evidence that long-term continuous calcium supplementation should be avoided if not mandatory," she concludes.

The study was supported by unrestricted philanthropic support to the Cleveland Clinic Heart, Vascular, and Thoracic Institute. The authors have no relevant conflicts of interest.

SOURCE: https://bit.ly/3K98T4t https://bit.ly/3rLvyNW Heart, online April 25, 2022.

By Reuters Staff

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