Moderate Dietary Calcium Intake May Protect Against CV and All-cause Mortality, Stroke

Sarfaroj Khan 


January 07, 2021


  • Moderate dietary calcium intake may be beneficial against cardiovascular (CV) and all-cause mortality and incident stroke compared with low and high intakes.

  • Calcium supplementation may be associated with decreased all-cause and CV mortality in women.

Why this matters

  • Findings suggest that people with risk factors for stroke should be encouraged to meet the UK dietary calcium recommendations of ≥700 mg/day, but not exceed a higher limit of 1255 mg/day.

  • Additionally, a moderate intake of dietary calcium (771-926 mg/day) may be a protective factor against mortality.

Study design

  • Data from European Prospective Investigation into Cancer, Norfolk (EPIC-Norfolk) prospective population-based study were used to evaluate the association between calcium intake and mortality and CV disease (17,968 participants aged 40-79 years; median follow-up period, 20.36 years).

  • Meta‑analysis of 27 prospective cohort studies including EPIC‑Norfolk study was performed, stratifying by average calcium intake using a 700 mg/day threshold.

  • Funding: EPIC-Norfolk received funding from the Medical Research Council and Cancer Research UK.

Key results

  • Compared with the first quintile of calcium intake (<770 mg/day), second (771-926 mg/day) and fourth quintiles (1074-1254 mg/day) were associated with decreased all-cause (adjusted HR [aHR], 0.91; 95% CI, 0.83-0.99 and 0.85; 95% CI, 0.77-0.93, respectively) and CV mortality (aHR, 0.79; 95% CI, 0.67-0.93 and 0.80; 95% CI, 0.67-0.95, respectively).

  • No significant association was seen between the third (1074-1254 mg/day) and fifth (≥1255 mg/day) quintiles of calcium intake and all-cause and CV mortality.

  • Compared with the first quintile of calcium intake, the second (aHR, 0.84; 95% CI, 0.72-0.97), third (aHR, 0.83; 95% CI, 0.71-0.97) and fourth (aHR, 0.78; 95% CI, 0.66-0.92), but not fifth (aHR, 0.95; 95% CI, 0.78-1.15), quintiles were associated with a lower rate of incident stroke.

  • Meta-analysis revealed that higher calcium intake was associated with lower all-cause mortality in studies with low average calcium intake (<700 mg/day) (risk ratio [RR], 0.89; 95% CI, 0.80-0.99) and those with high average calcium intake (≥700 mg/day) (RR, 0.93; 95% CI, 0.89-0.98).

  • Calcium supplementation was associated with lower all-cause (RR, 0.89; 95% CI, 0.87-0.91) and CV mortality (RR, 0.85; 95% CI, 0.77-0.94) in women, but not in men.


  • Risk for residual confounding.


Pana TA, Dehghani M, Baradaran HR, Neal SR, Wood AD, Kwok CS, Loke YK, Luben RN, Mamas MA, Khaw KT, Myint PK. Calcium intake, calcium supplementation and cardiovascular disease and mortality in the British population: EPIC-norfolk prospective cohort study and meta-analysis. Eur J Epidemiol. 2020 Dec 31 [Epub ahead of print]. doi: 10.1007/s10654-020-00710-8. PMID: 33382441 View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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