JACC Focus Seminar: Nutritional Supplements and the Heart
JACC Focus Seminar
Vitamin D, Calcium Supplements, and Implications for Cardiovascular Health: JACC Focus Seminar

https://doi.org/10.1016/j.jacc.2020.09.617Get rights and content
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Highlights

  • In observational studies, low blood levels of 25-hydroxyvitamin D have been associated with elevated cardiovascular risk.

  • In randomized trials, however, vitamin D supplementation has not reduced cardiovascular risk.

  • Some studies have found increased risk with calcium supplementation.

  • Available data suggest that calcium intake should derive largely from dietary sources.

Abstract

Vitamin 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.

Key Words

calcium
cardiovascular disease
prevention
randomized trials
supplements
vitamin D

Abbreviations and Acronyms

1,25(OH)2D
1,25-dihydroxyvitamin D
25(OH)D
25-hydroxyvitamin D
CHD
coronary heart disease
CI
confidence interval
CVD
cardiovascular disease
HR
hazard ratio
MI
myocardial infarction
NAM
National Academy of Medicine
RCT
randomized controlled trial
RR
relative risk

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