Postmenopausal Calcium and Vitamin D Supplements Controversy: Do They Increase Cardiovascular Risk?

Abstract

Calcium and vitamin D are prescribed in women with osteopenia-osteoporosis to prevent fractures. These bone events increase morbidity and mortality justifying therapy to prevent bone loss. These elderly patients also have cardiovascular risk factors, atherosclerosis and vascular calcifications. Multiple trials demonstrated a relationship between the latter, coronary events and cardiovascular mortality. In these patients, ectopic tissue mineralization may worsen cardiovascular outcome. Calcium intake correlates neither with serum calcium, vascular calcification nor cardiovascular events. However serum calcium-phosphate product is related to vascular calcification and outcome. The main cause for vascular calcification is systemic inflammation and local atherosclerotic process with specific interactions between macrophages and smooth muscle cells. This review examines calcium intake, serum calcium concentration, systemic and vascular inflammation, the mechanisms of vascular calcification and their impact on cardiovascular outcome.