Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92 019, Auckland 1142, New Zealand.
BMJ. 2010 Jul 29;341:c3691. doi: 10.1136/bmj.c3691.
To investigate whether calcium supplements increase the risk of cardiovascular events.
Patient level and trial level meta-analyses.
Medline, Embase, and Cochrane Central Register of Controlled Trials (1966-March 2010), reference lists of meta-analyses of calcium supplements, and two clinical trial registries. Initial searches were carried out in November 2007, with electronic database searches repeated in March 2010.
Eligible studies were randomised, placebo controlled trials of calcium supplements (>or=500 mg/day), with 100 or more participants of mean age more than 40 years and study duration more than one year. The lead authors of eligible trials supplied data. Cardiovascular outcomes were obtained from self reports, hospital admissions, and death certificates.
15 trials were eligible for inclusion, five with patient level data (8151 participants, median follow-up 3.6 years, interquartile range 2.7-4.3 years) and 11 with trial level data (11 921 participants, mean duration 4.0 years). In the five studies contributing patient level data, 143 people allocated to calcium had a myocardial infarction compared with 111 allocated to placebo (hazard ratio 1.31, 95% confidence interval 1.02 to 1.67, P=0.035). Non-significant increases occurred in the incidence of stroke (1.20, 0.96 to 1.50, P=0.11), the composite end point of myocardial infarction, stroke, or sudden death (1.18, 1.00 to 1.39, P=0.057), and death (1.09, 0.96 to 1.23, P=0.18). The meta-analysis of trial level data showed similar results: 296 people had a myocardial infarction (166 allocated to calcium, 130 to placebo), with an increased incidence of myocardial infarction in those allocated to calcium (pooled relative risk 1.27, 95% confidence interval 1.01 to 1.59, P=0.038).
Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.
研究钙补充剂是否会增加心血管事件的风险。
患者水平和试验水平的荟萃分析。
Medline、Embase 和 Cochrane 对照试验中心注册库（1966 年至 2010 年 3 月）、钙补充剂荟萃分析的参考文献列表以及两个临床试验注册处。初步搜索于 2007 年 11 月进行，2010 年 3 月再次进行电子数据库搜索。
合格的研究是随机、安慰剂对照的钙补充剂试验（每天>或=500 毫克），参与者平均年龄超过 40 岁，研究持续时间超过一年。合格试验的主要作者提供了数据。心血管结局来自自我报告、住院和死亡证明。
15 项试验符合纳入标准，其中 5 项具有患者水平数据（8151 名参与者，中位随访 3.6 年，四分位间距 2.7-4.3 年），11 项具有试验水平数据（11921 名参与者，平均持续时间 4.0 年）。在提供患者水平数据的五项研究中，143 名接受钙治疗的人发生心肌梗死，而 111 名接受安慰剂治疗的人发生心肌梗死（风险比 1.31，95%置信区间 1.02 至 1.67，P=0.035）。中风的发生率（1.20，0.96 至 1.50，P=0.11）、心肌梗死、中风或猝死的复合终点（1.18，1.00 至 1.39，P=0.057）和死亡（1.09，0.96 至 1.23，P=0.18）均无显著增加。试验水平数据的荟萃分析显示了类似的结果：296 人发生心肌梗死（166 人接受钙治疗，130 人接受安慰剂治疗），接受钙治疗的人发生心肌梗死的发生率增加（合并相对风险 1.27，95%置信区间 1.01 至 1.59，P=0.038）。
钙补充剂（不与维生素 D 同时服用）与心肌梗死风险增加相关。由于钙补充剂被广泛使用，这些心血管疾病风险的适度增加可能会给人群带来较大的疾病负担。有必要重新评估钙补充剂在骨质疏松症治疗中的作用。
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