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Calcium, vitamin D, HT combination improves LDL in postmenopausal women
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In postmenopausal women, a combination of calcium and vitamin D along with hormone therapy was shown to reduce LDL cholesterol, according to a secondary analysis of the Women’s Health Initiative.
“The well-documented beneficial effect that [HT] has on cholesterol parameters aside from triglycerides is felt to be moderate compared with other cholesterol-lowering therapies,” Peter F. Schnatz, DO, associate chair and residency program director at Reading Hospital in Pennsylvania, and colleagues wrote. “The data we present suggest an additive relationship with hormone therapy, which is modestly beneficial for some cardiovascular disease risk factors (LDL [cholesterol], [HDL cholesterol], total cholesterol, glucose, insulin, waist circumference and the waist-to-hip ratio) but modestly harmful for others (eg, systolic and diastolic blood pressure, triglycerides).”
Schnatz and colleagues analyzed data from 1,521 postmenopausal women who participated in the WHI, a prospective, randomized, double blind, placebo-controlled trial assessing the risks and benefits of dietary modification, HT and supplementation with calcium and vitamin D. Women were assigned to one of four groups: HT plus calcium and vitamin D (n = 378), HT alone (n = 373), calcium and vitamin D alone (n = 376), or neither HT nor calcium plus vitamin D (placebos; n = 394). Researchers measured lipid profile, BP, weight, waist circumference, waist-to-hip ratio, glucose and insulin at baseline and years 1, 3 and 6; the predefined primary outcome was LDL cholesterol.
Compared with the placebo group, women assigned to calcium plus vitamin D alone saw a mean –1.6 mg/dL decrease in LDL cholesterol (95% CI, –5.5 to 2.2); those assigned to HT alone saw a mean –9 mg/dL decrease; those assigned to calcium plus vitamin D and HT saw a mean –13.8 mg/dL decrease. The combination of HT with calcium plus vitamin D had a stronger effect on LDL cholesterol vs. HT or calcium plus vitamin D alone; however, the observed effects were additive, not synergistic, according to researchers (P for interaction = .26). Researchers observed a synergistic effect only in women with a low vitamin D intake (P for interaction = .03). Results did not vary by age (P = .59).
“For clinicians and most patients deciding to begin calcium-plus-vitamin D supplementation, current use of [HT] should not influence that decision,” the researchers wrote. “However, based on these findings, for women on estrogen and who have low intake of vitamin D, one should consider calcium-plus-vitamin D supplementation to lower LDL [cholesterol] that may decrease the risk of heart disease.” – by Regina Schaffer
Disclosure: One of the researchers reports receiving grants unrelated to the current research from Amgen, AstraZeneca and Bristol-Myers Squibb.
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