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Letters COMMENT & RESPONSE To the Editor Several recent articles documented increased car- diovascular mortality associated with high calcium intake, in Dietary and Supplemental Calcium Intake particular supplemental calcium. Most epidemiological stud- and Mortality ies of calcium intake and cardiovascular health have been con- ducted in white individuals with moderate to high calcium in- To the Editor The study by Xiao et al demonstrating increased take. Only a few specifically focused on cardiovascular cardiovascular risk from dietary calcium supplementation mortality. Xiao et al reported that supplemental calcium was highlights an important but underappreciated principle: the associated with elevated cardiovascular disease (CVD) mor- nontransitivity of clinical inference. In formal logic, if A im- tality in men but not in women, whereas dietary calcium in- plies B and B implies C, then it follows that A implies C. How- take was unrelated to CVD death in either sex. In contrast, an- ever, if calcium deficiency is associated with poor health out- other female cohort study showed that dietary calcium intake comes and calcium supplementation can raise calcium levels, above 1400 mg/d was associated with higher all-cause and CVD it does not necessarily follow that taking calcium supple- mortality compared with lower
JAMA Internal Medicine – American Medical Association
Published: Oct 28, 2013
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