Barreira-Hernández Diana, Rodríguez-Martín Sara, Gil Miguel, Mazzucchelli Ramón, Izquierdo-Esteban Laura, García-Lledó Alberto, Pérez-Gómez Ana, Rodríguez-Miguel Antonio, de Abajo Francisco J
Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), 28805 Alcalá de Henares, Spain.
Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency on Medicines and Medical Devices (AEMPS), 28022 Madrid, Spain.
J Clin Med. 2023 Aug 14;12(16):5294. doi: 10.3390/jcm12165294.
Conflicting results about the association of calcium supplements (CS) with ischemic stroke (IS) have been reported. We tested this hypothesis by differentiating between CS alone (CaM) and CS with vitamin D (CaD) and between cardioembolic and non-cardioembolic IS. We examined the potential interaction with oral bisphosphonates (oBs). A nested case-control study was carried out. We identified incident IS cases aged 40-90 and randomly sampled five controls per case matched by age, sex, and index date. Current users were compared to non-users. An adjusted odds ratios (AOR) and 95% CI were computed through conditional logistic regression. Only new users were considered. We included 13,267 cases (4400 cardioembolic, 8867 non-cardioembolic) and 61,378 controls (20,147 and 41,231, respectively). CaM use was associated with an increased risk of cardioembolic IS (AOR = 1.88; 95% CI: 1.21-2.90) in a duration-dependent manner, while it showed no association with non-cardioembolic IS (AOR = 1.05; 95% CI: 0.74-1.50); its combination with oBs increased the risk of cardioembolic IS considerably (AOR = 2.54; 95% CI: 1.28-5.04), showing no effect on non-cardioembolic. CaD use was not associated with either cardioembolic (AOR = 1.08; 95% CI: 0.88-1.31) or non-cardioembolic IS (AOR = 0.98; 95% CI: 0.84-1.13) but showed a small association with cardioembolic IS when combined with oBs (AOR = 1.35; 95% CI: 1.03-1.76). The results support the hypothesis that CS increases the risk of cardioembolic IS, primarily when used concomitantly with oBs.
关于钙补充剂（CS）与缺血性中风（IS）之间关联的研究结果相互矛盾。我们通过区分单纯钙补充剂（CaM）和钙与维生素D联合补充剂（CaD），以及心源性栓塞性和非心源性栓塞性缺血性中风，对这一假设进行了检验。我们还研究了其与口服双膦酸盐（oBs）的潜在相互作用。开展了一项巢式病例对照研究。我们确定了年龄在40 - 90岁的缺血性中风新发病例，并按年龄、性别和索引日期为每个病例随机抽取5名对照。将当前使用者与非使用者进行比较。通过条件逻辑回归计算调整后的优势比（AOR）和95%置信区间（CI）。仅考虑新使用者。我们纳入了13267例病例（4400例心源性栓塞性，8867例非心源性栓塞性）和61378名对照（分别为20147名和41231名）。使用CaM与心源性栓塞性缺血性中风风险增加相关（AOR = 1.88；95% CI：1.21 - 2.90），且呈剂量依赖关系，而与非心源性栓塞性缺血性中风无关联（AOR = 1.05；95% CI：0.74 - 1.50）；CaM与oBs联合使用会显著增加心源性栓塞性缺血性中风的风险（AOR = 2.54；95% CI：1.28 - 5.04），对非心源性栓塞性缺血性中风无影响。使用CaD与心源性栓塞性（AOR = 1.08；95% CI：0.88 - 1.31）或非心源性栓塞性缺血性中风（AOR = 0.98；95% CI：0.84 - 1.13）均无关联，但与oBs联合使用时与心源性栓塞性缺血性中风存在小的关联（AOR = 1.35；95% CI：1.03 - 1.76）。这些结果支持了以下假设：钙补充剂会增加心源性栓塞性缺血性中风的风险，主要是在与口服双膦酸盐同时使用时。
