The association of calcium supplementation and incident cardiovascular events in the Multi-ethnic Study of Atherosclerosis (MESA)

Nutr Metab Cardiovasc Dis. 2016 Oct;26(10):899-907. doi: 10.1016/j.numecd.2016.07.007. Epub 2016 Jul 16.


Background and aims: Many US adults use calcium supplements to address inadequate dietary intake and improve bone health. However, recent reports have suggested that use of calcium supplements may elevate cardiovascular disease (CVD) risk. In this study, we examined associations between baseline calcium supplement use and incident myocardial infarction (MI) (n = 208 events) and CVD events (n = 641 events) over 10.3 years in men and women from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort (n = 6236), with dietary calcium intake at baseline also examined as a supplementary objective.

Methods and results: Using Cox proportional hazards models, no compelling associations between calcium intake from supplements or diet and incident CVD events were observed upon multivariate adjustment for potential confounders. An association with lower MI risk was observed comparing those with low levels of calcium supplement use (1-499 mg) to those using no calcium supplements (hazard ratio 0.69, 95% CI 0.48, 0.98, p = 0.039). Relationships were homogeneous by gender, race/ethnicity, or chronic kidney disease. Results were also similar when the analysis was limited to postmenopausal women only.

Conclusion: Analysis of incident MI and CVD events in the MESA cohort does not support a substantial association of calcium supplement use with negative cardiovascular outcomes.

Keywords: Calcium; Cardiovascular disease; Multi-ethnic Study of Atherosclerosis; Myocardial infarction; Supplements.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Calcium / administration & dosage*
  • Calcium / adverse effects
  • Calcium, Dietary / administration & dosage
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / prevention & control
  • Cohort Studies
  • Dietary Supplements* / adverse effects
  • Female
  • Humans
  • Incidence
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / epidemiology
  • Postmenopause
  • Proportional Hazards Models
  • Protective Factors
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • United States / epidemiology


  • Calcium, Dietary
  • Calcium