The Role of Calcium in the Prevention of Cardiovascular Disease—A Review of Observational Studies and Randomized Clinical Trials

  • Susanne RautiainenEmail author
  • Lu Wang
  • JoAnn E. Manson
  • Howard D. Sesso
Nutrition (BV Howard, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Nutrition


Calcium is a mineral that is important for bone health and has also been suggested to play a role in the prevention of cardiovascular disease (CVD). Lately, the potential effects of both inadequate and excessive calcium intake have received growing attention. In this review, we summarize the evidence from experimental, epidemiologic, and clinical studies investigating the role of calcium intake, either from the diet or from supplements, as well as blood concentrations, in relation to the risk of CVD in adults. In vitro and in vivo laboratory studies suggest that calcium may be involved in CVD development through multiple pathways, including blood cholesterol, insulin secretion and sensitivity, vasodilation, inflammatory profile, thrombosis, obesity, and vascular calcification. Several prospective epidemiologic studies have examined how dietary or supplemental calcium intake is associated with CVD incidence or mortality in middle-aged and older adults, and the results are inconsistent. Prospective studies investigating blood concentrations of calcium have also reported mixed results. However, changes in blood calcium concentrations may reflect a disturbed calcium phosphate balance, which is associated with increased risk of CVD. To date there is no randomized clinical trial that has been designed specifically to test the effect of calcium supplementation on the risk of CVD as the primary end point. Existing trials have performed secondary analyses, and most of them have been conducted among postmenopausal women. These trials suggest that calcium supplementation has no effect on CVD development; however, they do not allow a definitive conclusion to be drawn. The average daily intake of calcium is low in many populations; however, the evidence for a potential role of dietary or supplemental calcium in the prevention of CVD remains insufficient and inconclusive. Only large-scale randomized trials designed to investigate the effects of calcium supplementation on CVD events as the primary end point, as well as short-term trials investigating the effect on coronary biomarkers, can provide a definitive answer.


Calcium Cardiovascular disease Cohort Randomized clinical trials Review 


Conflict of Interest

Susanne Rautiainen, Lu Wang, JoAnn E. Manson, and Howard D. Sesso declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Susanne Rautiainen
    • 1
    • 2
    • 5
    Email author
  • Lu Wang
    • 1
  • JoAnn E. Manson
    • 1
    • 3
  • Howard D. Sesso
    • 1
    • 3
    • 4
  1. 1.Division of Preventive Medicine, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Institute of Environmental Medicine, Karolinska InstituteStockholmSweden
  3. 3.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  4. 4.Division of Aging, Department of MedicineBrigham and Women’s HospitalBostonUSA
  5. 5.Division of Preventive MedicineBrigham and Women’s HospitalBostonUSA

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