• Cynthia A Thomson, Aaron K Aragaki, Ross L Prentice, Marcia L Stefanick, JoAnn E Manson, Jean Wactawski-Wende, Nelson B Watts, Linda Van Horn, James M Shikany, Thomas E Rohan, Dorothy S Lane, Robert A Wild, Rogelio Robles-Morales, Aladdin H Shadyab, Nazmus Saquib, and Jane Cauley.
• Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (C.A.T.).
• Ann. Intern. Med. 2024 Apr 1; 177 (4): 428438428-438.

BackgroundAlthough calcium and vitamin D (CaD) supplementation may affect chronic disease in older women, evidence of long-term effects on health outcomes is limited.ObjectiveTo evaluate long-term health outcomes among postmenopausal women in the Women's Health Initiative CaD trial.DesignPost hoc analysis of long-term postintervention follow-up of the 7-year randomized intervention trial of CaD. (ClinicalTrials.gov: NCT00000611).SettingA multicenter (n = 40) trial across the United States.Participants36 282 postmenopausal women with no history of breast or colorectal cancer.InterventionRandom 1:1 assignment to 1000 mg of calcium carbonate (400 mg of elemental calcium) with 400 IU of vitamin D3 daily or placebo.MeasurementsIncidence of colorectal, invasive breast, and total cancer; disease-specific and all-cause mortality; total cardiovascular disease (CVD); and hip fracture by randomization assignment (through December 2020). Analyses were stratified on personal supplement use.ResultsFor women randomly assigned to CaD versus placebo, a 7% reduction in cancer mortality was observed after a median cumulative follow-up of 22.3 years (1817 vs. 1943 deaths; hazard ratio [HR], 0.93 [95% CI, 0.87 to 0.99]), along with a 6% increase in CVD mortality (2621 vs. 2420 deaths; HR, 1.06 [CI, 1.01 to 1.12]). There was no overall effect on other measures, including all-cause mortality (7834 vs. 7748 deaths; HR, 1.00 [CI, 0.97 to 1.03]). Estimates for cancer incidence varied widely when stratified by whether participants reported supplement use before randomization, whereas estimates on mortality did not vary, except for CVD mortality.LimitationHip fracture and CVD outcomes were available on only a subset of participants, and effects of calcium versus vitamin D versus joint supplementation could not be disentangled.ConclusionCalcium and vitamin D supplements seemed to reduce cancer mortality and increase CVD mortality after more than 20 years of follow-up among postmenopausal women, with no effect on all-cause mortality.Primary Funding SourceNational Heart, Lung, and Blood Institute of the National Institutes of Health.

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