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Calcium/Vitamin D-related CV Events Based on Poster 1163

Calcium/Vitamin D-related CV Events Based on Poster 1163 “Risk of Cardiovascular Events with Calcium/Vitamin D – a Re-Analysis of the Women’s Health Initiative” Mark Bolland, Andrew Grey, Gregory Gamble, Ian Reid Monday, October 18, 2010 ASBMR 2010 Toronto, Ontario. Background.

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Calcium/Vitamin D-related CV Events Based on Poster 1163

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  1. Calcium/Vitamin D-related CV Events • Based on Poster 1163 • “Risk of Cardiovascular Events with Calcium/Vitamin D – a Re-Analysis of the Women’s Health Initiative” • Mark Bolland, Andrew Grey, Gregory Gamble, Ian Reid • Monday, October 18, 2010 • ASBMR 2010 • Toronto, Ontario

  2. Background • • A consistent pattern of increased myocardial infarction (MI) risk from calcium supplementation vs. placebo was demonstrated in a meta-analysis of 11,900 subjects (Bolland et al. IOF 2010, Abstract OC25) • • Reid et al. re-analyzed the interaction between BMI and the calcium/vitamin D intervention in the Women’s Health Initiative (WHI) • • As part of the WHI, postmenopausal women received 1 g calcium plus 400 IU vitamin D or placebo and were followed for 7 years • • At baseline, 54% (20,000) of the cohort were already taking personal calcium supplements and approximately 16,000 women were not

  3. • For non-obese women (BMI<30 kg/m2) randomized to calcium/vitamin D, there was a significant increased risk for: • – A revascularization procedure (28%) • – Total MI, coronary heart disease, death and revascularization (24%)

  4. Results • • In women not taking personal calcium supplements at baseline, a significant increase in MI and combined stroke/MI was observed • • In women taking personal calcium supplements at baseline, there was no evidence of altered cardiovascular disease (CVD) events • • The addition of vitamin D therefore did not abrogate the effect of calcium on CVD end points except in obese women

  5. Other Studies on Calcium/Vitamin D and Vascular Events • • In a meta-analysis of 3 such studies, the HR was similar to that identified in the WHI where the combination of calcium/vitamin D increased the risk of MI by 21% and stroke by 20% • • Given the similarity of the CVD risk between calcium alone and calcium + vitamin D, it is reasonable to hypothesize that the addition of vitamin D to calcium does not make a substantive difference to CVD risk

  6. Meta-analysis of Calcium ± Vitamin D Effect on Stroke • Based on the meta-analysis, a 15% increase in the combination of MI and stroke is associated with calcium supplementation with or without vitamin D

  7. Summary • According to these data, if 1000 people were treated with calcium for 5 years (± Vitamin D), this would result in an estimated increase of: • MIs = 4x • Stroke = 4x • Deaths = 2x • At the same time, 3 fractures would be prevented. • Findings suggest that reassessment of the role of calcium supplementation ± vitamin D in osteoporosis prevention and treatment is warranted

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