Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
Already Have An Account? Log in Now
Vitamin D, Calcium Supplements, and Implications for Cardiovascular Health
TAKE-HOME MESSAGE
-
Observational and randomized, controlled studies have produced conflicting results regarding the effects of vitamin D supplements and calcium supplements on cardiovascular health, and this review provides a detailed discussion of the current evidence with recommendations for using supplements appropriately.
-
The review provides important information about supplements that are commonly used to help clinicians provide up-to-date, evidence-based guidance to patients to aid in making wise choices regarding vitamin D and calcium supplementation, including consideration of potential cardiovascular harm associated with calcium supplementation.
abstract
This abstract is available on the publisher's site.
Access this abstract nowVitamin D and calcium supplements are commonly used, often together, to optimize bone health. Multiple observational studies have linked low serum 25-hydroxyvitamin D concentrations with increased cardiovascular risk. However, subsequent randomized controlled trials (RCTs) failed to demonstrate cardiovascular benefit with vitamin D supplementation. Although vitamin D supplements do not appear to be harmful for cardiovascular health, the lack of benefit in RCTs should discourage their use for this purpose, favoring optimizing vitamin D status through healthy lifestyles such as specific foods and modest sunlight exposure. Furthermore, some (but not all) observational and RCT studies of calcium supplementation have suggested potential for cardiovascular harm. Therefore, calcium supplementation should be used cautiously, striving for recommended intake of calcium predominantly from food sources. In this review, the authors examine the currently available evidence investigating whether vitamin D and calcium supplements are helpful, harmful, or neutral for cardiovascular health.
Additional Info
Disclosure statements are available on the authors' profiles:
Vitamin D, Calcium Supplements, and Implications for Cardiovascular Health: JACC Focus Seminar
J Am Coll Cardiol 2021 Feb 02;77(4)437-449, ED Michos, M Cainzos-Achirica, AS Heravi, LJ AppelFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Primary Care
Vitamin D and Calcium Supplementation
“Eat a high-fiber, plant-based diet with some fish and go outside and play.”
This is the take-home message of this review in JACC regarding recommendations for vitamin D and calcium supplementation in relation to heart health. Eat foods rich in vitamin D and calcium with weight-bearing exercises to maintain bone strength and absorb sunlight to make vitamin D in the skin.
In those who are not deficient, supplementing with vitamin D does not benefit the heart and supplementing with calcium may increase the risk of a heart attack. This is important for the general public to know as calcium supplements are used by 40% of adults.
What To Recommend to Those Who Are Deficient or at Risk for Osteoporosis?
Two large vitamin D studies (ViDA and VITAL) revealed that, even in the groups that were deficient, there was not a protective effect to CV health, but the studies may have not been long enough to show cause and effect.
The National Academy of Medicine (NAM) has modified recommendations for treating vitamin D deficiency. In the past, levels of 25-hydroxy vitamin D were considered deficient at < 30 ng/mL; but, as data have accumulated, NAM updated these to the following:
These data suggest avoiding supplementation unless 25-hydroxy vitamin D levels are ≤20 ng/dL, with better evidence for benefit when levels are <12 ng/mL.
For calcium, smaller doses (approximately 500 mg) are better absorbed than larger doses. For someone who is at high risk for osteoporosis, calcium with vitamin D is better than calcium alone. For those who are not able to get enough calcium through the diet, the recommended dose is 1000–1200 mg a day in divided doses; but, due to the risk, shared decision–making is encouraged.
For osteoporosis, I recommend 600 mg of calcium, 1000 IU of D3, good nutrition (to get another 600 mg through diet), and weight-bearing exercises. Vitamin D benefits calcium absorption from food, allowing for a lower calcium supplement dose.
Although there is a risk of CV events with calcium supplementation from a pill, there is no evidence of harm when calcium is obtained through food.
Here is a nice graphic summary from the paper:
“Eat a high-fiber, plant-based diet with some fish and go outside and play.”The bottom line remains: