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期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2598

摘要内容如下：

背景

虽然钙和维生素D（CAD）补充剂可能影响老年妇女的慢性疾病，但对健康结果的长期影响的证据有限。

客观

评估妇女健康倡议CAD试验中绝经后妇女的长期健康结果。

设计

冠心病7年随机干预试验干预后长期随访的事后分析。（ClinicalTrials.gov：NCT00000611）

设置

全美多中心（n=40）试验。

参与者

36282无乳腺癌或结肠直肠癌病史的绝经后妇女。

干预

随机1:1分配至每日1000mg碳酸钙（400mg元素钙）和400IU维生素D3或安慰剂。

测量

结直肠癌、浸润性乳腺癌和总癌的发病率；特定疾病死亡率和全因死亡率；总心血管疾病（CVD）；以及随机分配的髋部骨折（至2020年12月）。对个人补充剂的使用进行分层分析。

结果

与安慰剂组相比，随机分配到CAD组的妇女，在中位累积随访22.3年后观察到癌症死亡率降低7%（1817例对1943例死亡；风险比[HR]，0.93[95%CI，0.87至0.99]），同时CVD死亡率增加6%（2621对2420例死亡；HR，1.06[CI，1.01至1.12]）。对其他指标没有总体影响，包括全因死亡率（7834对7748例死亡；HR，1.00[CI，0.97至1.03]）。当根据参与者在随机化前是否报告使用补充剂进行分层时，癌症发病率的估计值变化很大，而死亡率的估计值没有变化，但心血管疾病死亡率除外。

局限性

髋部骨折和心血管疾病的结果仅适用于一部分参与者，并且钙、维生素D和关节补充剂的影响无法分开。

结论

对绝经后妇女进行20多年的随访，钙和维生素D补充剂似乎降低了癌症死亡率，增加了心血管疾病死亡率，但对全因死亡率没有影响。

主要资金来源

美国国立卫生研究院的国家心脏、肺和血液研究所。

英文原文如下：

Abstracts

BACKGROUND  Although calcium and vitamin D (CaD) supplementation may affect chronic disease in older women, evidence of long-term effects on health outcomes is limited.

OBJECTIVE  To evaluate long-term health outcomes among postmenopausal women in the Women's Health Initiative CaD trial.

DESIGN  Post hoc analysis of long-term postintervention follow-up of the 7-year randomized intervention trial of CaD. (ClinicalTrials.gov: NCT00000611).

SETTING  A multicenter (n = 40) trial across the United States.

PARTICIPANTS  36 282 postmenopausal women with no history of breast or colorectal cancer.

INTERVENTION  Random 1:1 assignment to 1000 mg of calcium carbonate (400 mg of elemental calcium) with 400 IU of vitamin D3 daily or placebo.

MEASUREMENTS  Incidence 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.

RESULTS  For 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.

LIMITATION  Hip 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.

CONCLUSION  Calcium 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 SOURCE  National Heart, Lung, and Blood Institute of the National Institutes of Health.

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