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Background  Recent randomized data suggest that calcium supplements may be associated with increased risk of cardiovascular disease ( CVD ) events. Using a longitudinal cohort study, we assessed the association between calcium intake, from both foods and supplements, and atherosclerosis, as measured by coronary artery calcification ( CAC ).    Methods and Results  We studied 5448 adults free of clinically diagnosed  CVD  (52% female; aged 45–84 years) from the Multi‐Ethnic Study of Atherosclerosis. Baseline total calcium intake was assessed from diet (using a food frequency questionnaire) and calcium supplements (by a medication inventory) and categorized into quintiles. Baseline  CAC  was measured by computed tomography, and  CAC  measurements were repeated in 2742 participants ≈10 years later. At baseline, mean calcium intakes across quintiles were 313.3, 540.3, 783.0, 1168.9, and 2157.4 mg/day. Women had higher calcium intakes than men. After adjustment for potential confounders, among 1567 participants without baseline  CAC , the relative risk ( RR ) of developing incident  CAC  over 10 years, by quintile 1 to 5 of calcium intake, were 1 (reference), 0.95 (0.79–1.14), 1.02 (0.85–1.23), 0.86 (0.69–1.05), and 0.73 (0.57–0.93). After accounting for total calcium intake, calcium supplement use was associated with increased risk for incident  CAC  ( RR =1.22 [1.07–1.39]). No relation was found between baseline calcium intake and 10‐year changes in log‐transformed  CAC  among those participants with baseline  CAC  >0.    Conclusions  High total calcium intake was associated with a decreased risk of incident atherosclerosis over long‐term follow‐up, particularly if achieved without supplement use. However, calcium supplement use may increase the risk for incident  CAC .

journal of the american heart association

Calcium Intake From Diet and Supplements and the Risk of Coronary Artery Calcification and its Progression Among Older Adults: 10‐Year Follow‐up of the Multi‐Ethnic Study of Atherosclerosis ( MESA )