From the Guidelines
Calcium and vitamin D supplementation does not accelerate atherosclerosis in generally healthy adults when taken at recommended levels, as evidenced by the lack of association found in recent clinical guidelines. The National Osteoporosis Foundation and the American Society for Preventive Cardiology have concluded that calcium intake from food and supplements, not exceeding the tolerable upper level of intake (2000 to 2500 mg/d), is considered safe from a cardiovascular standpoint 1. Key points to consider include:
- The recommended daily intake for most adults is 1000-1200 mg of calcium, though individual needs may vary based on age, sex, and health status.
- Vitamin D, which helps with calcium absorption, has numerous health benefits, including potential protective effects against cardiovascular disease through its anti-inflammatory properties and role in regulating blood pressure.
- Excessive calcium supplementation might potentially contribute to calcium deposition in blood vessels in some individuals, particularly those with kidney disease or existing cardiovascular conditions, but this is not a concern at recommended intake levels.
- Calcium is essential for bone health and should be obtained primarily through diet when possible, with supplements used judiciously to fill gaps, as supported by the evidence review team at Tufts University 1.
- If you have concerns about cardiovascular disease, it's best to discuss appropriate supplementation with your healthcare provider, who can consider your specific risk factors and health needs, based on the clinical guideline developed by the National Osteoporosis Foundation and the American Society for Preventive Cardiology 1.
From the Research
Calcium and Vitamin D's Effect on Atherosclerosis
- The relationship between calcium, vitamin D, and atherosclerosis is complex, with some studies suggesting that vitamin D may have protective effects against atherosclerosis 2.
- Vitamin D has been shown to protect against endothelial dysfunction, vascular smooth muscle cell proliferation and migration, and modulation of the immune system, as well as the inflammatory response 2.
- However, the picture for calcium is more complex, with dietary intake of calcium potentially being associated with lower CVD risk, while calcium supplementation may elevate CVD risk 3.
- Some studies suggest that vitamin D deficiency is associated with an increased risk of cardiovascular disease, including atherosclerosis 4.
Risk Assessment and Prevention
- Risk assessment is a critical step in the primary prevention of atherosclerotic cardiovascular disease, and knowledge of the 10-year risk for atherosclerotic cardiovascular disease can help identify patients who are likely to have greater net benefit from statins and antihypertensive therapy 5.
- The pooled cohort equations are widely validated and useful for the general U.S. clinical population, but may systematically underestimate risk in certain patient groups 5.
- Additional testing, such as measurement of coronary artery calcium, can be useful to reclassify risk estimates and improve selection of patients for use or avoidance of statin therapy 5.
Calcium and Vitamin D Supplementation
- The evidence for calcium and vitamin D supplementation in preventing atherosclerosis is mixed, with some studies suggesting potential benefits and others raising concerns about potential harms 3, 4.
- The Institute of Medicine has provided recommendations regarding the use of vitamin D and calcium supplements, and clinicians should consider these guidelines when making decisions about supplementation 3.