USA: A new study published in the British Medical Journal suggests that in older individuals with mild-moderate aortic stenosis (AS), calcium supplementation with or without vitamin D is related to lower survival and increased aortic valve replacement (AVR).
Aortic stenosis has long been linked to calcium metabolism. Studies on the long-term safety of oral calcium and/or vitamin D in AS are few, but necessary given the growing use among an elderly population prone to insufficiency. As a result, Nicholas Kassis and colleagues undertook this study to investigate the links between supplementary calcium and vitamin D and AS mortality and progression.

Patients aged 60 years with mild-moderate native AS were recruited from the Cleveland Clinic Echocardiography Database between 2008 and 2016 and monitored till 2018. The groups were divided into three categories: no supplementation, vitamin D supplementation alone, and calcium±vitamin D supplementation. The primary objectives were mortality (all-cause, CV, and non-CV), as well as aortic valve replacement; the secondary outcomes were AS progression by aortic valve area and peak/mean gradients.
The key findings of this study were as follows:
1. Of the 2657 patients (mean age 74 years, 42% women) followed for a median of 69 months, 1292 (49%) were not in supplement, 332 (12%) took vitamin D alone, and 1033 (39%) supplemented with calcium±vitamin D.
2. Calcium±vitamin D supplementation was linked to a significantly higher risk of all-cause mortality (absolute rate (AR)=43.0/1000 person-years; HR=1.31), CV mortality (AR=13.7/1000 person-years; HR=2.0), and AVR (AR=88.2/1000 person-years; HR=1.4.
3. In a linear mixed-effects model, no supplementation was linked with longitudinal changes in AS parameters.
In conclusion, these data imply that calcium supplementation, with or without vitamin D, has no cardiovascular advantages in older people with mild to moderate aortic stenosis and may be linked with an increased risk of death.
Reference:
Kassis, N., Hariri, E. H., Karrthik, A. K., Ahuja, K. R., Layoun, H., Saad, A. M., Gad, M. M., Kaur, M., Bazarbashi, N., Griffin, B. P., Popovic, Z. B., Harb, S. C., Desai, M. Y., & Kapadia, S. R. (2022). Supplemental calcium and vitamin D and long-term mortality in aortic stenosis. In Heart (p. heartjnl-2021-320215). BMJ. https://doi.org/10.1136/heartjnl-2021-320215