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Heart attack risks & calcium

Mothers have been telling us for decades to drink our milk to have strong bones. They are not necessarily wrong; calcium from diet is essential. However, what about calcium from supplements?
Many people, especially women after menopause, take calcium supplements as a preventive measure to reduce the chances of osteoporosis. Patients who have osteoporosis are instructed to take calcium to prevent fracture.
In a meta-analysis, 1200 mg of calcium plus 800 mg of vitamin D resulted in preservation of bone mineral density at the hip and spine. In fact, there was a 12 percent reduction in the risk of fracture in patients taking this combination.
The demographics included people over the age of 50. So, you can understand why patients would readily use calcium supplements.

Is it possible that calcium supplementation is dangerous?
A meta-analysis that looked at five randomized control trials in 2007, showed that calcium taken without vitamin D may increase the risk of a heart attack. Patients who had a heart attack had calcification (hardening) of the coronary arteries. The average dose of calcium supplementation was approximately 1000 mg.
In the treatment group, there was a 31 percent increase in incidence of heart attack, compared to the placebo group. The authors recommended at the time that most of your calcium come from diet.
I agree that it is important to take calcium and vitamin D together; vitamin D helps with the absorption of calcium. However, high levels of calcium may interfere with vitamin D’s functioning.
Still, a study published in the British Medical Journal in 2011 illustrated that calcium with vitamin D increased the risk of a heart attack by about 20 percent. The authors analyzed data from the Women’s Health Initiative, with over 20,000 participants.
The most damaging impact to calcium supplementation is the authors’ conclusion that for every 1000 people taking calcium for five years, regardless of vitamin D intake, there would be an increase of six heart attacks or strokes, but prevention of only three fractures.
This may mean that the risks outweigh the benefits with calcium supplementation. The study used 1000 mg of calcium and 400 IUs of vitamin D. The conclusion of the authors is that patients should get most of their calcium from diet.

What are the different types of calcium supplementation?
The two common types are calcium carbonate and calcium citrate. Calcium carbonate is less expensive, found in products like Tums, and it has a higher propensity to cause the most common type of kidney stone, calcium oxalate stones.
Calcium citrate is better absorbed. Therefore, I recommend to my patients, if they take calcium, it should be calcium citrate.

What is the optimal dose of calcium?
We see all varying doses of calcium on pharmacy shelves. The body absorbs <500 mg of calcium most effectively at one time, according to the Institute of Medicine. Therefore, it is best to target this amount. Also, the studies above showed an increase in heart attack with 1000 mg of calcium supplementation. Where should we get most of our calcium?
Even though it is not completely clear what to do about calcium supplementation, there is a recurrent theme of recommending dietary calcium. Interestingly, there was a study that showed that a diet rich in calcium, but not in vitamin D or dairy, lowered risk of death due to ischemic heart disease.
Foods that are naturally high in calcium include soybeans and vegetables, such as kale and bok choy. High levels of sodium and protein cause decreased levels of calcium.
There is definitely value in supplementing vitamin D in patients who are insufficient or deficient, but most people, including those with osteoporosis or osteopenia, may not have low levels of calcium. So, if patients have normal levels, there is no need for them to take calcium supplements.

Seven Factors for Preventing Heart Disease

What if I told you that you could practically eliminate your chances of getting heart disease? The risk of mortality from heart disease has decreased by 30 percent over the last few decades, which is impressive. However, before we start celebrating, it is still the number one cause of death in the U.S. – in 2019, heart disease was responsible for one in four deaths.

The Seven Factors
The good news is that several key studies examine ways to reduce heart disease risk factors. If we improve seven key modifiable risk factors, the chance of heart disease goes down to about one percent.
These seven factors are smoking, body mass index, physical activity, diet, total cholesterol without medication, blood pressure without medication and fasting blood glucose without medication.
What did the researchers find?
In one study, researchers found that we are doing best with smoking cessation. The prevalence of nonsmoking ranged from 60-90 percent, depending on demographics. On the other hand, Healthy Diet Scores were not very good; from 0.2 to 2.6 percent of participants achieved ideal levels. Obviously, diet is an area that needs attention. This observational study involved 14,515 participants who were at least 20 years old.
How many participants actually reached all seven goals? About one percent. This means we have the ability to alter our history of heart disease dramatically. There is also a direct relationship between the effort you apply to attain these goals and your outcome of reduced risk.
In another study, those who had an optimal risk factor profile at age 55 were significantly less likely to die from cardiovascular disease than those who had two or more risk factors. These differences were maintained through at least age 80.
The lifetime risk of fatal heart disease or a nonfatal heart attack in the optimal group was less than one percent for women and 3.6 percent for men. In terms of sex differences, men were ten times less likely and women were eighteen times less likely to die from heart disease if they were in the optimal risk stratification group.
This was a meta-analysis of 18 observational studies with more than 250,000 participants.

Dietary Approaches
Several diets have shown dramatic results in preventing and treating heart disease, such as the Ornish, DASH (Dietary Approaches to Stop Hypertension), Mediterranean-type, and Esselstyn diets.
These diets all have one thing in common: they rely on nutrient-dense, plant-based foods. Both the Ornish and Esselstyn diets showed reversal of atherosclerosis in studies and, as we know, atherosclerosis (plaques in the arteries) is the foundation for heart disease.

Exercise’s Effects
For the most beneficial effects on preventing heart disease, both the ACSM (American College of Sports Medicine) and the US Department of Health and Human Services recommend that most Americans get at least 30 minutes of moderate aerobic exercise five times a week, for a total of 150 minutes, or 75 minutes of vigorous aerobic exercise per week.
Moderate aerobic exercise includes brisk walking, as demonstrated in the Women’s Health Initiative, a large observational study. This study showed a 28 to 53 percent reduction in heart disease risk in women ages 50 to 79.
Resistance training is also very important. The Health Professionals’ Follow-up Study showed at least 30 minutes a week resulted in a 23 percent heart disease risk reduction, and running for only 60 minutes resulted in a 42 percent risk reduction.
Interestingly, although medications may be important for people who have high levels of blood pressure, cholesterol and glucose, they do not get you to the lowest risk stratification. Lifestyle modification is the only way to approach ideal cardiovascular health.
Thus, if we worked on these factors to achieve the appropriate levels, this disease would no longer be at the top of the list for mortality.

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