Dr. Bill Elliott: Calcium supplements may harm heart

COULD YOUR CALCIUM supplements be harmful to your heart? The answer may be yes based on new evidence from the Women’s Health Initiative (WHI) study. This surprising finding is the result of some diligent work by a group of researchers from New Zealand who took a new look at the WHI, the huge research study that has looked at the health of more than 160,000 women from 1991 until the present.

Calcium supplementation is one of the most commonly recommended “healthy lifestyle” interventions, especially for women over the age of 50. There is evidence that calcium plus vitamin D improves bone health, and up until now calcium has been considered relatively safe with the only major side effect being an increased risk of kidney stones.

Calcium supplementation has been particularly popular since 2002 when the first link between hormone replacement therapy and breast cancer became known. Prior to that, hormone supplementation was the primary weapon against bone loss for postmenopausal women. Ironically the hormone/cancer link was the first major finding of WHI.

Calcium, however, may not be as safe as we once thought. Last year, researchers from New Zealand published a study that suggested that calcium supplementation may be associated with an increased risk of cardiovascular disease, stroke and heart attack.

The speculation was that rapid increases in calcium levels caused by taking calcium pills might make the blood more sticky and contribute to hardening of the arteries. The concern was only with calcium pills — not dietary calcium.

Increasing dietary calcium causes gradual increases in calcium that is not believed to be harmful to arteries. The New Zealand researchers got their data from a number of small studies and although their conclusions were interesting, their research paper did not garner much attention, especially in this country.

To further test their thesis about the risk of calcium, the New Zealand researchers decided to reanalyze data from WHI. It seemed a strange place to look since WHI had specifically looked at the issue of calcium supplementation and had not found a relationship to cardiovascular disease.

There was one important caveat, however, that was overlooked in the original publication — many of the women who enrolled in WHI were already taking calcium when they started the study. The New Zealand group looked specifically for women who had not been taking calcium when they enrolled in WHI. Of the 17,000 women who met this criteria, some were started on calcium pills as part of the study and the others remained on no calcium. It was this group that was evaluated in this new research study.

The results were published online last week in the British medical journal BMJ. The researchers found that women who started calcium supplementation had a small, but statistically significant increase in the risk of cardiovascular disease especially heart attack. The risk was only associated with calcium supplementation and not with vitamin D supplementation.

Their conclusions were: “Calcium supplements with or without vitamin D modestly increase the risk of cardiovascular events, especially myocardial infarction (heart attack), a finding obscured in the WHI CaD Study by the widespread use of personal calcium supplements. A reassessment of the role of calcium supplements in osteoporosis management is warranted.”

These findings bring up a couple of important questions for older women and their doctors: Does the risk of taking calcium out weigh the benefit? And if women are already taking calcium should they stop?

Most experts believe that women need extra calcium to maintain healthy bones. There is also good evidence that adequate vitamin D levels are essential for good bone health. Weightbearing exercise stresses the bones and makes them stronger; walking, running and resistance exercises all are beneficial.

But calcium supplementation? This is an issue that will need more research.

Everyone can agree that a diet high in calcium is important and beneficial. If a woman is able to calculate the amount of calcium in the diet, and she is able to consume at least 1,200 mg a day, then there is no need for supplementation. On the other hand, if she is not able to take in adequate dietary calcium and is at low risk for heart disease, then taking a supplement may be beneficial.

If a woman is at high risk for heart disease, however, the question becomes more complicated. Women with known heart disease, hypertension, diabetes or high cholesterol may want to discuss this issue with their doctor before starting calcium supplements.

This discussion centers almost entirely on women because they at are much higher risk of osteoporosis and fractures than men. Most men do not need calcium supplementation, and based on this recent study, men should not be routinely taking calcium unless there is a specific medical need.

Event will focus on making women’s health a priority

Female employees of local government and colleges will be able to attend an event Thursday called “Nourishing Body and Mind” at the Bismarck Civic Center.

Women, who are often caregivers for others in their lives, may forget to focus on their own health, said Wanda Agnew, director of nutrition services for Bismarck Burleigh Public Health.

This event will offer mini-workshops on health topics as well as a keynote speaker, Barb Marchello, who will discuss local foods and North Dakota food traditions.

Female employees of the city of Bismarck, Burleigh County, the Bismarck Park District, the University of Mary, United Tribes Technical College, Rasmussen College and Bismarck State College who attend will be encouraged to make personal health and wellness a priority, Agnew said.

Doors open at 4 p.m. and the event begins at 5 p.m. in the Civic Center’s Upper Level Exhibit Hall, Prairie Rose Rooms.

Marchello will give her keynote address at 5:15 p.m.

The mini-workshops will include information on whole grain flour, outdoor activities offered by North Dakota Game and Fish department, sleep concerns and money management. More than 40 vendor booths also will be available.

Among other concerns, women attending will hear about the importance of several steps to incorporate into their daily lives, including:

- Getting at least 2 1/2 hours of moderate physical activity, or 1 hour 15 minutes of vigorous physical activity, or a combination of the two, each week.

- Eating a nutritious diet.

- Visiting a health care professional for regular checkups and preventative screenings.

- Avoiding risky behaviors such as smoking and not wearing a seatbelt.

- Paying attention to mental health, including getting enough sleep and and managing stress.

The U.S. Department of Health and Human Services Offices-Women’s Health supports these women’s health events.

Women’s Health a Priority for LLUMC

Loma Linda University Medical Center is taking several steps to educate women in the community on all the hospital has to offer – both at their physical location and online.

“Women are the major health care providers for their families, and they need to take care of themselves,” said Beverly Rigsby, service line development director, GYN, women’s urology, ENT, and robotic and minimally invasive services. “I am a mother of three girls, and I find it difficult to make time for myself. We make it as simple and easy and in one place as we can.”

There’s no typical female patient that walks through the doors of LLUMC.

“It depends on their age,” said Rigsby. “For younger women, it’s mostly for their yearly GYN appointment, and if they’re pregnant, it’s for OB. Once they hit 45, they go to imaging, and hopefully they never hit cancer. Around 40 to 45, other services that we start using are incontinence for those with difficulty after childbirth, mammograms, and hysterectomy surgery. We do have more female patients, largely because of labor and delivery, but also because women use the health care system more than men.”

Female specific offerings at the LLUMC include female pelvic medicine and reconstructive surgery; women’s imaging; robotic and minimally invasive surgery center; and OB/GYN. Breast ultrasounds, mammograms, robotic or laproscopic surgery, infertility services and women’s heart services are just some of the services.

“With our robotic and minimally invasive surgery center, it causes much less bleeding, less time in hospital, and is much easier on the patient,” Rigsby said. “Usually they can be back to work in a week or two.”

OB brings in women with on-track pregnancies as well as high risk.

“We have high risk OB, so if there’s something wrong or they worry about it, if the mom is high risk, we get all the referrals in the region,” Rigsby said. “We have a fairly large NICU, if they’re worried about the baby being delivered.”

Online, the women’s health website answers common women’s health questions, and has links to specific hospital departments and services, like urogynecology and female pelvic health. Rigsby started the online women’s center in 2006.

“We had a website company that helped us with the structure of it and the outline of it, and I ended up doing a lot of the specific information for each area that pertained to what I was working on,” Rigsby said. “Cancer for example goes to the cancer website after the initial introduction, and the same for heart.”

To promote women’s health even further, LLUMC hosts a women’s health event every November, which features educational sessions, free giveaways and lunch.

“It started three years ago with the marketing department,” Rigsby said. “750 attended last year, and it’s part of our community outreach. Women can come and learn more about their health, and we have keynote speakers. They can learn about how to deal with stress in their life during breakout sessions, as well as about women’s heart conditions, diabetes, weight loss, plastic surgery and incontinence.”

The hospital continues to expand, with LLUMC welcoming new staff members this spring, including a female doctor in the female pelvic medicine reconstructive surgery department.

“That’s big because a lot of women like to go to females,” Rigsby said.

Also coming aboard is a new infertility physician, and soon OB/GYNs will be hired to the growing robotic and minimally invasive surgery department.

“We’ve just hired a new department chair for OB, and he is a gynecologic oncologist,” Rigsby said. “He operates on cancer of the pelvis, uterine, all of those cancers. He is robotic minimally invasive trained, and looking at growing that area by hiring two or three more people to do just minimally invasive surgery for cancer in women.”

While LLUMC doesn’t have a women’s center with everything in one spot, they are working towards that, as well as continuing to get the word out about women’s health.

“I think the website was a start,” Rigsby said. “We’ve been doing seminars in the community, and would like to do more of those. There’s more information we want to get out there.”