Calcium Intake, Calcium Supplementation and Cardiovascular Disease and Mortality in the British Population: EPIC-Norfolk Prospective Cohort study and Meta-Analysis

Tiberiu Pana, Mohsen Dehghani, Hamid Baradaran, Samuel R. Neal, Adrian Wood, Chun Shing Kwok, Yoon Kong Loke, Robert N Luben, Mamas A Mamas, Kay-Tee Khaw, Phyo K Myint* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)
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Background: The role of dietary calcium in cardiovascular disease prevention is unclear.Objective: To determine the association between calcium intake and incident cardiovascular disease and mortality.Methods: Data were extracted from the European Prospective Investigation of Cancer, Norfolk (EPIC-Norfolk). Multivariable Cox regressions analysed associations between calcium intake (dietary and supplemental) and cardiovascular disease (myocardial infarction, stroke, heart failure, aortic stenosis, peripheral vascular disease) and mortality (cardiovascular and all-cause). The results of this study were pooled with those from published prospective cohort studies in a meta-analsyis, stratifying by average calcium intake using a 700 mg/day threshold.Results: A total of 17,968 participants aged 40-79 years were followed up for a median of 20.36 years (20.32-20.38). Compared to the first quintile of calcium intake (<770 mg/day), intakes between 771-926 mg/day (second quintile) and 1074-1254 mg/day (fourth quintile) were associated with reduced all-cause mortality (HR 0.91 (0.83-0.99) and 0.85 (0.77-0.93), respectively) and cardiovascular mortality (HR 0.95 (0.87-1.04) and 0.93 (0.83-1.04)).17 Compared to the first quintile of calcium intake, second, third, fourth, but not fifth quintiles were associated with fewer incident strokes: respective HR 0.84 (0.72-0.97), 0.83 (0.71- 0.97), 0.78 (0.66-0.92) and 0.95 (0.78-1.15). The meta-analysis results suggest that high levels of calcium intake were associated with decreased all-cause mortality, but not cardiovascular mortality regardless of average calcium intake. Calcium supplementation wasassociated with cardiovascular and all-cause mortality amongst women, but not men. Conclusions: Moderate dietary calcium intake may protect against cardiovascular and all cause mortality and incident stroke. Calcium supplementation may reduce mortality in women.
Original languageEnglish
Pages (from-to)669-683
Number of pages15
JournalEuropean Journal of Epidemiology
Issue number7
Early online date31 Dec 2020
Publication statusPublished - 31 Jul 2021

Bibliographical note

Open Access via the Springer Compact Agreement

Acknowledgements: We are grateful to all the participants who have been part of the project and to the many members of the study teams at the University of Cambridge who have enabled this research. We would also like to acknowledge the principal investigators and staff of the EPIC-Norfolk study. The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136).


  • Dietary calcium
  • calcium supplements
  • Cardiovascular Disease
  • Systematic Review
  • meta-analysis
  • mortality


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