Meta-analysiscited by the Tayebat archiveabstract only checked A-SUP-02 standard review
Calcium + vitamin D and heart attacks (WHI reanalysis)
Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis.
Overview
Bolland MJ et al.. BMJ 2011 · PMID 21505219 · DOI 10.1136/bmj.d2040
In women not already using calcium, calcium plus vitamin D was linked to about 13–22% more CV events.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
CaD and CV.
- How was the study done?
Reanalysis + MA.
- How many people, animals or samples were studied?
WHI + 8 trials.
- What was actually found?
Modest increase.
- How large was the observed effect?
RR 1.24 MI.
- What do the results mean in everyday life?
Uncertain.
- What are the study's limitations?
Post-hoc.
- What does it say about Elawady's specific claim?
Partly supports.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Settled harm.
Scientific in-depth review
1. Full reference
- Authors
- Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR
- Journal
- BMJ
- Year
- 2011
- Identifier
- PMID 21505219 DOI 10.1136/bmj.d2040 · PMC3079822
- Verification
- verified – PubMed E-utilities efetch, 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that no author has support from companies for the submitted work; IRR has received research support from and acted as a consultant for Fonterra and had study medications for clinical trials of calcium supplementation supplied by Mission Pharmacal, and AA had study medications for clinical trials of calcium supplementation supplied by Shire Pharmaceuticals and Nycomed; no other relationships or activities that could appear to have influenced the submitted work.
2. Research question
Do calcium supplements with or without vitamin D increase CV risk?
3. Study design and population
- Study design
- Meta-analysis – Reanalysis of WHI CaD limited-access dataset plus meta-analysis
- Population
Postmenopausal women (WHI) + 8 trials
- Country
USA/multinational
- Period
WHI 7-year RCT
- Sample size
36,282 WHI; 28,072 in trial-level meta-analysis
- Inclusion and exclusion criteria
see abstract
4. Methods and endpoints
- Exposure / intervention
Calcium ± vitamin D
- Comparator
Placebo
- Endpoints
MI, revascularisation, CHD death, stroke
- Statistical methods
Subgroup by personal calcium use; meta-analysis
5. Actual results
- Results
WHI women not using personal calcium: HR 1.13–1.22; meta-analysis of 3 trials CaD: MI RR 1.21 (1.01–1.44), stroke 1.20 (1.00–1.43); overall MI RR 1.24 (1.07–1.45).
- Absolute risks
not reported in abstract
- Authors' conclusion
Calcium with or without vitamin D modestly increases CV events, especially MI.
6. Strengths
- Uses RCT data
7. Weaknesses
- Post-hoc subgroup analysis
- Same author group
- Secondary outcomes
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Post-hoc subgroup restriction raises risk of selective analysis.
9. Assessment of the statistical interpretation
See results.
10. Relevance to the specific claim
11. Independent contrary findings
Chung 2016 (I-SUP-06).
12. Transferability to Germany and Europe
High: biology and trial populations comparable to European adults.
13. Overall methodological judgement
Contested post-hoc reanalysis.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | inconsistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | essentially correct but incomplete |
14. Open questions
15. Linked fact checks
Use by the Tayebat archive
Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.
- What the archive says about the study
Listed in the archive bibliography of the oral-supplements rule without its own interpretation; used implicitly to support the rule summary that supplements 'failed or caused harm' in large trials.
- A. What was actually studied?
Do calcium supplements with or without vitamin D increase CV risk?
- B. What did the authors find?
WHI women not using personal calcium: HR 1.13–1.22; meta-analysis of 3 trials CaD: MI RR 1.21 (1.01–1.44), stroke 1.20 (1.00–1.43); overall MI RR 1.24 (1.07–1.45).
- C. What conclusions do the authors themselves draw?
Calcium with or without vitamin D modestly increases CV events, especially MI.
- D. What does the archive derive from it?
Supports claim that vitamin D does not erase the harm.
- E. Is this derivation scientifically justified?
Partly; contested reanalysis.
- Adequacy of the interpretation (by the archive)
- essentially correct but incomplete