Calcium/Vitamin D Modestly Trims LDL in Postmenopausal Women

March 11, 2014

PHILADELPHIA, PA — Postmenopausal women who received calcium and vitamin-D supplementation for two years had significantly lower LDL-cholesterol levels compared with women who did not receive the dietary supplements, a new study shows[1].

The reduction in LDL cholesterol, however, was small, just 4.5 mg/dL, and it is unknown if such a reduction would translate into a clinically meaningful benefit on cardiovascular outcomes.

Still, investigators say the results support the use of calcium/vitamin-D supplementation in this population, particularly if the individual has low serum 25-hydroxyvitamin D concentrations (25-OHD3), the active metabolite of vitamin D. In the analysis, which was led by Dr Peter Schnatz (Thomas Jefferson University, Philadelphia, PA) and published online March 5, 2014 in Menopause, supplementation with calcium/vitamin D increased mean serum 25-OHD3 concentrations 38%, and higher concentrations of the metabolite were associated with lower LDL-cholesterol and triglyceride levels, as well as higher HDL-cholesterol levels.

Dr Margery Gass (Case Western Reserve University School of Medicine, Cleveland, OH), who was not involved in the publication but serves as the executive director of the North American Menopause Society, said it is very common for physicians, especially gynecologists, to recommend calcium/vitamin-D supplementation in postmenopausal women, given the bone loss that occurs at the time of menopause. She said the data suggesting a benefit of supplementation, particularly with vitamin D, on cardiovascular measurements are not well-known.

"The vitamin-D literature is very mixed, so it's a challenge to tease out what's really happening," Gass told heartwire . "Even though these results come from a randomized controlled trial, the placebo group in the study was not prohibited from using multivitamins and their own vitamin D. That is why looking at serum levels of vitamin D in this study was important. Higher levels appeared to correlate with a greater effect on cholesterol levels."

The study, a randomized, double-blind, placebo-controlled trial of the Women's Health Initiative (WHI), was designed to test the effects of calcium/vitamin-D supplementation on hip fracture risk in postmenopausal women. The present analysis focused solely on 600 women, including 300 white participants, 200 African American participants, and 100 Hispanic participants, to determine the effect of calcium/vitamin D on plasma 25-OHD3 concentrations and lipid levels.

Overall, 25-OHD3 concentrations were significantly increased in the treatment arm, with women taking calcium/vitamin D twice as likely to have concentrations >30 ng/mL. As noted, LDL-cholesterol levels were reduced, a small reduction but statistically significant. Higher levels of 25-OHD3 correlated with higher HDL-cholesterol levels and lower triglycerides.

To heartwire , Gass said the cardiovascular outcomes from these small cholesterol changes are unknown. "It's a very modest change compared with something like a lipid-lowering drug," she said. "Because of that, following current vitamin-D and calcium-supplement guidelines is still advisable."

To know the real benefits of vitamin-D supplementation, physicians and patients will have to wait until the results of the Vitamin D and Omega-3 Trial (VITAL) are in. That National Institutes of Health (NIH)–sponsored study, led by Drs JoAnn Manson and Julie Buring (Brigham and Women's Hospital, Boston, MA), will test whether supplementation with vitamin D3 (2000 IU) or omega-3 fatty acids (1000 g) reduces the risk of heart disease, stroke, or cancer in 20 000 healthy men and women.

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