Do Calcium Supplements Increase Heart Attack Risk?

Written by Dr. Steve Chaney on . Posted in current health articles, Supplements and Health

 

Calcium Confusion

Author: Dr. Stephen Chaney

 cardiovascular-disease

Should you avoid calcium supplements? Do calcium supplements increase heart disease risk? If you’ve been reading some of the recent headlines in magazines, newspapers and current health articles, that’s exactly what you might think.

And, after years of telling us that calcium supplements may be important for bone health, even some doctors are now recommending that their patients avoid calcium supplements. So what’s the truth? What should you believe?

Calcium Confusion

While some headlines and blogs have been telling you to avoid “killer calcium” supplements at all cost, the actual literature on the subject is much more confusing. Some studies claim that taking over 1,000 mg of supplemental calcium is associated with a slight (20-24%) increase in heart attack risk (Bolland et al, BMJ, 341: c3691, 2010; Bolland et al, BMJ 342: d2040, 2011; Xiao et al, JAMA Internal Medicine, 173: 639-646, 2013). Other studies find no association between supplemental calcium intake and heart attack risk or decreased heart attack risk (Lansetmo et al, J Clin Endocrinol Metab, 98: 3010-3018, 2013; Wang et al, Am J Cardiovasc Drugs, 12:105-116, 2012).

Why the confusion? It turns out that most of these studies had some significant limitations – particularly the studies reporting increased heart attack risk. For example:

  • Some studies were too small or the follow-up was too short. As a consequence the total number of cardiovascular deaths was so small that it was difficult to have confidence in small differences between the group supplementing with calcium and the one that was not supplementing.
  • Some of the papers represented a re-analysis of the data from studies that were actually designed to measure whether calcium supplements decreased risk of bone fracture, not whether they increased the risk of cardiovascular death. That is a concern because it means that cardiovascular deaths were not systematically recorded at the time the studies were performed.

And when studies like that are poorly designed, you end up with some pretty bizarre findings. For example:

  • One study reported that calcium supplementation increased the risk of heart attack only in women who were using no calcium supplements prior to the study. A second study by the same authors reported that calcium supplementation increased heart attack risk only women who were taking calcium supplements prior to the study. Obviously, both studies couldn’t be correct.
  • One study has reported that calcium supplementation increases heart attack risk in women, but not in men. Another study reports that calcium supplementation increases heart attack risk in men, but not in women. A third study claims that calcium supplementation reduces cardiovascular death in women, but not in men. Again, all of those studies can’t be true.

Are you confused yet? If so, I have good news for you. The definitive study on calcium supplements and heart attack risk in humans has just been published.

 

Do Calcium Supplements Increase Heart Attack Risk?

A group of scientists from Brigham and Women’s Hospital in Boston and Harvard University analyzed the relationship between supplemental calcium use and cardiovascular disease in 74,245 women with no previous history of heart disease who were enrolled in the Nurses’ Health Study (Paik et al, Osteoporosis International, doi: 10.1007/s00198-014-2732-2, 2014). This was a very well designed study that avoided the flaws of the previous studies. For example:

  • There were a large number of women in the study (74,245) and a long follow-up (24 years). As a consequence there were a large number of adverse cardiovascular events (2,709 deaths and 1,856 strokes). This allowed for a very precise statistical comparison of calcium supplement users and non-users.
  • This study was designed to measure cardiovascular disease and cardiovascular deaths
  • This study was also designed to measure calcium intake. In fact, calcium intake was measured every 4 years.

The results were pretty clear cut:

  • Women taking >1,000 mg of supplemental calcium/day had an 18% decrease in cardiovascular deaths.
  • Women taking >1,000 mg of supplemental calcium/day had a 29% decrease in cardiovascular disease.
  • When they looked at total calcium intake (dietary and supplemental) women consuming >2,000 mg/day had an 18% decrease in cardiovascular deaths compared to women consuming <500 mg/day (about the average dietary intake for American women).
  • It didn’t make any difference whether the women were at high or low risk of heart disease (smokers versus non-smokers, high blood pressure versus normal blood pressure, high cholesterol versus normal cholesterol, heart healthy diet or poor diet, pre- or post-menopause, etc)
  • It also didn’t make any difference if the women started supplementing with calcium during the last 4 years of the study or had been supplementing with calcium for 24 years. The results were essentially the same.

 

The Bottom Line

1)     You can ignore the “Killer Calcium” headlines and the warnings that taking calcium supplements will increase your risk of heart disease. The definitive study for women has just been published, and it shows that >1,000 mg/day of supplemental calcium reduces your risk of cardiovascular disease by 29% and cardiovascular death (primarily heart attacks) by 18%.

2)     The definitive study for men has not yet been published, but it is likely that the results will be similar to those for women.

3)     On the other hand, there is clear evidence that calcium intake in the 1000 to 1300 mg per day range (the current RDA recommendations) decreases the risk of osteoporosis, and osteoporosis can significantly decrease quality of life and even lead to increased mortality. Most people aren’t getting enough calcium in their diet. For these people appropriate calcium supplementation is clearly advantageous.

4)     Finally, as I discuss in my book “The Myths of the Naysayers” (available for free to subscribers of “Health Tips From the Professor”), some poorly designed calcium supplements could indeed have the potential to increase heart disease risk. My recommendation is to make sure that your calcium supplement contains 800 to 1200 IU of vitamin D per day plus RDA levels of the other nutrients needed for bone formation (vitamin C, vitamin K, magnesium, zinc, copper and manganese).

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 

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Comments (4)

  • Helen

    |

    Thank you for this professional and timely information you provide. Most appreciative of your work and effort.

    How does one get your book re: Naysayers?

    HTG

    Reply

    • Dr. Steve Chaney

      |

      Dear Helen,

      When you go to https://www.healthtipsfromtheprofessor.com and register to receive my health tips on a weekly basis you will receive an email with instructions on how to receive your free Naysayers eBook.

      Dr. Chaney

      Reply

  • sharry zacharia

    |

    Thank you for clearing the confusion on CA intake and heart disease.

    Reply

  • Mary Ahrens

    |

    thank you Dr. Chaney for simplifying the results for each of these studies! It’s incredibly helpful!

    Reply

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Latest Article

Omega-3 Benefits: Lower High Blood Pressure

Posted July 16, 2019 by Dr. Steve Chaney

What Does the FDA Say About Omega-3 Benefit Claims?

Author: Dr. Stephen Chaney

 

 

Among omega-3 benefits is lower high blood pressure.  That claim can be made according to the FDA. 

lower high blood pressureHeart Disease is still the number 1 cause of death in this country. And, while deaths from heart disease have been declining in recent years, deaths due to high blood pressure have been increasing.  That is concerning because:

High blood pressure is a killer! It can kill you by causing heart attacks, strokes, congestive heart failure, kidney failure and much more.

High blood pressure is a serial killer. It doesn’t just kill a few people. It kills lots of people. The American Heart Association estimates that high blood pressure directly or indirectly caused 410,000 deaths in 2014. That is almost 1 person every second and represents a 41% increase from 2000. It’s because high blood pressure is not a rare disease.

  • 32% of Americans have high blood pressure, also called hypertension, (defined as a systolic blood pressure of 140 mm Hg or more or a diastolic blood pressure of 90 mm Hg or more).
  • Another 33% of Americans have prehypertension (systolic blood pressure of 120-139 mm Hg or diastolic blood pressure of 80-89 mm Hg).

That’s over 65% of Americans with abnormal blood pressure!

High blood pressure is a silent killer. That’s because it is a very insidious disease that sneaks up on you when you least expect it. Systolic blood pressure increases 0.6 mm Hg/year for most adults over 50. By age 75 or above 76-80% of American adults will have high blood pressure.  Even worse, many people with high blood pressure have no symptoms, so they don’t even know that their blood pressure is elevated. For them the first symptom of high blood pressure is often sudden death.

Blood pressure medications can harm your quality of life. Blood pressure medications save lives. However, like most drugs, blood pressure medications have a plethora of side effects – including weakness, dizziness, fainting, shortness of breath, chest pain, nausea, diarrhea or constipation, heartburn, depression, heart palpitations, and even memory loss. The many side effects associated with blood pressure medications lead to poor compliance, which is probably why only 46% of patients with high blood pressure are adequately controlled.

You do have natural options. By now you are probably wondering whether there are natural approaches for controlling your blood pressure that are both effective and lack side effects. The answer is a resounding YES! I’ll outline a holistic natural approach for keeping your blood pressure under control in a minute but let me start with the FDAs recent approval of what they call “qualified claims” that omega-3s lower blood pressure.

 

What Does the FDA Say About Omega-3 Benefits?

omega-3 benefitsIn my book “Slaying The Supplement Myths” I talk about the “dark side” of the supplement industry. There are far too many companies who try to dupe the public by making outrageous and unsubstantiated claims about their products.

Only the FDA stands between us and those unscrupulous companies, and they take their role very seriously. That is why it is big news whenever the FDA allows companies to make health claims about their products.

Even then, the FDA is very cautious. They allow what they call “qualified” health claims. Basically, that means they are saying there is enough evidence that the health claim is probably true, but not enough evidence to say it is proven.

Of course, if you understand the scientific method, you realize there will always be some studies on both sides of every issue. That is why the only health claims the FDA allows are qualified health claims.

With that background in mind, let’s look at the qualified health claims the FDA allows for omega-3 benefits.

  • Since 2004 the FDA has allowed the qualified claim “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”
  • A few weeks ago, they added five qualified health claims about omega-3s and blood pressure. The 5 claims are very similar, so I will only list two below for the sake of brevity.
  • “Consuming EPA and DHA combined may reduce blood pressure and reduce the risk of hypertension, a risk factor for CHD (coronary heart disease).”
  • Consuming EPA and DHA combined may reduce the risk of CHD (coronary heart disease) by lowering blood pressure.
  • Of course, they add the usual wording about the evidence being inconsistent and inconclusive.

 

Omega-3 Benefits?

measure omega-3 benefits levelWe’ve known for some time that omega-3 fatty acids help lower blood pressure, but two recent studies were instrumental in convincing the FDA to allow these qualified health claims. These studies have highlighted just how strong the effect of omega-3s on lowering blood pressure is.

The first study was a meta-analysis of 70 randomized, placebo-controlled clinical trials of long chain omega-3 (EPA + DHA) supplementation and blood pressure (Miller et al, American Journal of Hypertension, 27: 885-896, 2014 ).

This study showed:

  • In the group with normal blood pressure at the beginning of the study EPA + DHA supplementation decreased systolic blood pressure by 1.25 mm Hg.
  • Given that systolic blood pressure rises an average of 0.6 mm Hg/year in adults over 50, the authors estimated that omega-3 supplementation alone would delay the onset of age-related high blood pressure by 2 years.
  • In the group with elevated blood pressure not taking medication at the beginning of the study, EPA + DHA supplementation decreased systolic blood pressure by an impressive 4.51 mm Hg and diastolic blood pressure by 3.05 mm Hg.
  • The authors noted that this decrease in systolic blood pressure could “prevent an individual from requiring medication [with all its side effects] to control their hypertension” or decrease the amount of medication required.

However, the doses of omega-3s used in these studies ranged from 1 to over 4 grams/day (mean dose = 3.8 grams/day). That sparked a second study (Minihane et al, Journal of Nutrition, 146: 516-523, 2016) to see whether lower levels of omega-3s might be equally effective. This study was an 8-week double-blind, placebo-controlled study comparing the effects of 0.7 or 1.8 grams of EPA + DHA per day (versus an 8:2 ratio of palm and soybean oil as a placebo) on blood pressure.

This study showed:

  • In the group with normal blood pressure at the beginning of the study, EPA + DHA supplementation caused no significant decrease in blood pressure. This could be due to the smaller number of subjects or the lower doses of EPA + DHA used in this study.
  • In the group with elevated blood pressure not taking medication at the beginning of the study, EPA + DHA supplementation decreased systolic blood pressure by 5 mm Hg and, the effect was essentially identical at 0.7 grams/day and 1.8 grams/day.
  • The authors concluded “Our data suggest that increased EPA + DHA intakes of only 0.7 grams/day may be an effective strategy for blood pressure control.”

 

A Holistic Approach to Lower High Blood Pressure

holistic approach to lower high blood pressureThe FDA’s allowed claims about omega-3s are good news indeed, but that’s not the only natural approach that lowers blood pressure. You have lots of other arrows in your quiver. For example:

  • The DASH diet (A diet that has lots of fresh fruits and vegetables; includes whole grains, low fat dairy, poultry, fish, beans, nuts and oils; and is low in sugar and red meats) reduces systolic blood pressure by 5-6 mm Hg. [Low fat, low carb and Mediterranean diets also lower blood pressure, but not by as much as the DASH diet].
  • Reducing sodium by about 1,150 mg/day reduces systolic blood pressure by 3-4 mm Hg.
  • Reducing excess weight by 5% reduces systolic blood pressure by 3 points.
  • Doing at least 40 minutes of aerobic exercise 3-4 times/week reduces systolic blood pressure by 2-5 mm Hg.
  • Nitrates, whether derived from fresh fruits and vegetables or from supplements probably also reduce blood pressure, but we don’t yet know by how much.

If you’ve been keeping track, you’ve probably figured out that a holistic lifestyle that included at least 0.7 grams/day of long chain omega-3s (EPA + DHA) plus the other omega-3 benefits in the list above could reduce your systolic blood pressure by a whopping 18-22 mm Hg.  What

That’s significant because, the CDC estimates that reducing high systolic blood pressure by only 12-13 mm Hg could reduce your risk of:

  • Stroke by 37%.
  • Coronary heart disease by 21%.
  • Death from cardiovascular disease by 25%.
  • Death from all causes by 13%.

 

A Word of Caution

While holistic approaches have the potential to keep your blood pressure under control without the side effects of medications, it is important not to blindly rely on holistic approaches alone. There are also genetic and environmental risk factors involved in determining blood pressure. You could be doing everything right and still have high blood pressure. Plus, you need to remember that high blood pressure is a silent killer that often doesn’t have any detectable symptoms prior to that first heart attack or stroke.

My recommendations are:

  • Monitor your blood pressure on a regular basis.
  • If your blood pressure starts to become elevated, consult with your doctor about starting with natural approaches to bring your blood pressure back under control. Doctors are fully aware of the side effects of blood pressure medications, and most doctors are happy to encourage you to try natural approaches first.
  • Continue to monitor blood pressure as directed by your doctor. If natural approaches are insufficient to bring your blood pressure under control, they will prescribe the lowest dose of blood pressure medication possible to get your blood pressure where it needs to be.
  • Don’t stop making holistic lifestyle choices to reduce blood pressure just because you are on medication. The more you do to keep your blood pressure under control with a healthy diet and lifestyle, the less medication your doctor will need to use (That means fewer side effects).

 

The Bottom Line

Heart Disease is still the number 1 cause of death in this country. And, while deaths from heart disease have been declining in recent years, deaths due to high blood pressure have been increasing. That is why anything we can do lower blood pressure naturally is important. What does the FDA say about omega-3s and blood pressure?

  • Since 2004 the FDA has allowed the qualified claim “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”
  • A few weeks ago, they added qualified health claims about omega-3s and blood pressure. For example, they now allow the following claims.
  • “Consuming EPA and DHA combined may reduce blood pressure and reduce the risk of hypertension, a risk factor for CHD (coronary heart disease).”
  • Consuming EPA and DHA combined may reduce the risk of CHD (coronary heart disease) by lowering blood pressure.

For more information on the studies that convinced the FDA to allow claims about omega-3s and blood pressure and for a discussion of holistic natural approaches for lowering blood pressure, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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