Posts Tagged ‘calcium’

Calcium Will Kill Me? – Audio

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

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Calcium Will Kill Me?

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I hope everyone had a good easter.  We had some different easter eggs this year.  My parents spent the winter in Texas and came back with some special eggs for their grand kids.  They are actual egg shells with a nice colorful paint job.  On the inside, though, the eggs were filled with confetti.  My mom said in Mexico and Texas the kids would break them over each other’s heads.  So, after finding the eggs my children were encouraged to go outside and break confetti eggs on each other’s head.  This whole egg-breaking confetti spilling thing was very surprising to me as my mother was always very neat when I was growing up.

The other surprising thing this week was the calcium phone call I got.  A long time customer called on the phone.  She said a girlfriend of hers was watching the news and it said taking calcium would cause heart attacks.  Did I know anything about that?  The answer was no, so I started looking into it.

So what do we know?  There was a really big study done in 2002 called the Women’s Health Initiative Study.  We’ve talked about it before in relation to hormone replacement.  This time we are talking about calcium and vitamin D.  The Women’s Health Initiative (WHI) study also looked to see if calcium and vitamin D caused heart problems.  When the WHI published its results, it said there was no evidence that calcium and vitamin D caused heart problems.

Another group led by Bolland, et. al,  looked at the WHI numbers again.  Bolland  et. al. published a paper in the British Medical Journal that said the original WHI conclusions were wrong about the calcium.  In the WHI calcium trial there were women taking calcium and vitamin D and women on a placebo.  But Bolland didn’t like that the WHI group let all the women use their own calcium plus vitamin d if they wanted.  So that means some of the women on the placebo were actually taking calcium and vitamin D.  So Bolland said the WHI trial really looked at women who were taking a large dose of calcium plus vitamin D versus those that were taking a small dose.  Bolland says this masked the results.

So the Bolland group went back through the WHI study and tried to tease out women who were actually taking no calcium and match them up with women who were taking calcium.  These women were 63 years old on average and Bolland looked at over 36,000 of them.  The bottom line in this study was that if you treat 1000 women for 5 years with calcium and vitamin D you will prevent 3 fractures.  But if you treat those same 1000 women for 5 years with calcium and vitamin D you would cause 6 heart attacks or strokes.

That sounds serious, doesn’t it?  No one wants to be one of those 6 women who got a heart attack or stroke.  But remember the odds are low.  It would take 1000 women taking calcium for 5 years to get those 6 heart attacks and strokes.  Looking at the numbers another way, that is 1.2 heart attacks or strokes per 1000 woman years of calcium and vitamin D.  If you want to look at things that are truly bad for heart attacks and strokes, look at smoking.  In 1991 LaCroix et al published a study in the New England Journal of Medicine that said women between the ages of 65-69 died from heart attacks and strokes at a rate of 15.9 deaths per 1000 women years of smoking.  That is nearly 8 times worse than the calcium.  In a 1997 study in the International Journal of Epidemiology, Haapanen et al looked at women between the ages of 35-63 in Finland.  The women who exercised the least got heart disease at a rate of 8.8 per 1000 woman years.  This is about 4 times worse than the calcium reported effects.

The calcium study looked at some other odd things.  Just like in the hormone version of the WHI, in the calcium arm, the women were 63 years old on average.  That is at least 10 years later than we would normally put someone on calcium.  The study authors said that women who were already on calcium didn’t seem to have this increased risk of heart and stroke.  So maybe this calcium effect just says we shouldn’t start a woman in her mid-60’s on calcium if she has never had it before.

The authors of the calcium study didn’t find that the women died more often.  This may seem like a minor point, because no one wants to get a heart attack or stroke.  That is true, but if adding calcium was really that bad, why didn’t more women in the calcium arm die of heart attacks and strokes than in the non-calcium arm?

Will my calcium pills kill me?  The answer still is that we don’t know.  It is an important question for the scientists to look into, but I don’t think anyone should throw out their calcium pills yet.  If you are worried about your heart, do some things we know that will help.  Get some exercise.  Current guidelines say 150 minutes of exercise per week.  That is 20-30 minutes of exercise per day.  So let’s get on those walking shoes and start that 10 minute walk in the morning and 10 minute walk at night.  And the number one thing you can do to help your heart is to quit smoking.

British Medical Journal Article about calcium and heart attacks: http://www.bmj.com/content/342/bmj.d2040.full.pdf

NEJM article about smoking and older men and women : http://www.nejm.org/doi/full/10.1056/NEJM199106063242303

International Epidemiology article on exercise in older men and women: http://ije.oxfordjournals.org/content/26/4/739.full.pdf

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

If you have any topics you want us to write about, email us at dcp@mymts.net or call 638-4602.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

Does Calcium Cause Heart Attacks? – Audio

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

DOES CALCIUM CAUSE HEART ATTACKS?

 

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Who knew a census could be exciting?  This summer, Stephen Harper’s Conservative Government told everyone they were going to get rid of the long form census.  This got everyone from Francophone’s to Municipal Governments to businesses excited.  You see many, many people rely on the information from the census to make their policy decisions.   The Harper Conservatives said the long form census was intrusive.  They didn’t like that the current legislation threatened jail time if someone didn’t complete it.  The part of the debate I found exciting, though, was the lie.  Industry Minister Tony Clement said Statistics Canada believed the information collected from a voluntary survey would be as accurate as that from a mandatory census.  This lie so upset head of Statistics Canada, Munir Sheikh, that he quit in protest.

There was another mis-truth this summer that more directly affected me.  I not saying the media lied when they started saying calcium supplements caused heart attacks, but it wasn’t the whole truth.  Let me tell you my story.  I had a customer in her seventies call me out to the vitamin aisle.  She had been taking calcium supplements for years, but now she had heard that it would cause heart attacks.  She wanted to know how much calcium she should take to keep her bones strong, but not so much as to give her a heart attack.

Where did this fear inspiring headline come from?  There was a study done in New Zealand and published in the July 29, 2010 British Medical Journal by Mark J. Bolland et al.  The study was a meta-analysis.  Although different types of studies might sound boring, this is important.  The best type of study is called a double-blind placebo controlled trial.  In this type of trial a drug is given to half the study participants and a sugar pill is given to the other half.  Neither the study participants nor the researchers know who gets what until after the study is over.  That way we can be sure that an effect found in the drug group was really caused by the drug.  A meta-analyis is different.  The researchers in New Zealand never ran a trial at all.  They took a bunch of other people’s trials, threw the results into a computer and looked at what came out.  A meta-analyis has several inherent problems.  Were the researchers biased when the picked the trials they included?  Were the trials done in similar ways?  You can’t mash an apple and an orange together and expect to get apple sauce just because they are both fruit.  In the same way, not all studies are set up the same way and their results can’t always be mashed together.

Meta-analyses are not terrible things.  But, I my opinion, they should usually be done to generate a new hypothesis for a new double-blind placebo controlled trials to test.  They shouldn’t be plastered all over the news as the “truth”.  When a meta-analysis hits the papers saying calcium supplements cause heart attacks, people over react.  This meta-analysis from New Zealand said people over the age of 40 who take 500 mg or more of calcium per day have more heart attacks than those who don’t.  One theory to explain this is that too much calcium might harden the blood vessels.

Don’t throw out your calcium supplements yet.  Remember this was a meta-analysis.  In fact another meta-analyis published by Wang, et. al in the March 2, 2010 Annals of Internal Medicine looked at this issue from a slightly different angle.  They looked to see if calcium plus Vitamin D prevented heart problems.  The studies they looked at showed a some evidence Vitamin D prevented heart problems, but it wasn’t strong.  They found calcium didn’t seem to effect heart problems one way or the other.  So the experts haven’t decided yet if calcium effects the heart or not.  So you shouldn’t stop your calcium because you are worried about heart attacks.  The jury is still out on that.

Why should you take calcium supplements? The main reason to take calcium is to help keep your bones strong.  The current recommendation is 1000-1200 mg of calcium per day.  Should you take them with or without Vitamin D?  Calcium should be taken with Vitamin D because Vitamin D helps the gut absorb calcium.  The current recommendation is 800 to 2000 IU of Vitamin D per day.  If we treat 50 post-menopausal women with 1000 mg of calcium per day for 5 years, we will prevent one fracture.  As we get older a broken bone is not just an inconvenience.  It can mean the difference between staying in your own home or ending up in a hospital or nursing home.  Another study by Haentjens et. al in March 16, 2010 Annals of Internal Medicine says older adults are 5-8 times more likely to die in the first 3 months after a hip fracture than people their age that didn’t break a hip.  So the benefits of calcium and Vitamin D can be huge.

So remember not everything you hear from a politician or on a new report are always true.  Get a second opinion before the next health story you hear on the news makes you want to panic.

We are always looking for new ideas for these articles.  If you have any topic suggestions, please email us at dcp@mymts.net.

BMJ Article: Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis – http://www.bmj.com/content/341/bmj.c3691.full

Annals of Internal Medicine abstract: Systematic Review: Vitamin D and Calcium Supplementation in Prevention of Cardiovascular Events – http://www.annals.org/content/152/5/315.abstract

 As always if you have any questions or concerns about these products, ask your pharmacist.

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