Calcium Plus Vitamin D Supplementation and Health Outcomes Five Years After Active Intervention Ended: The Women's Health Initiative

被引:83
作者
Cauley, Jane A. [1 ]
Chlebowski, Rowan T. [2 ]
Wactawski-Wende, Jean [3 ]
Robbins, John A. [4 ]
Rodabough, Rebecca J. [5 ]
Chen, Zhao [6 ]
Johnson, Karen C. [7 ]
O'Sullivan, Mary Jo [8 ]
Jackson, Rebecca D. [9 ]
Manson, JoAnn E. [10 ]
机构
[1] Univ Pittsburgh, Pittsburgh, PA 15261 USA
[2] Harbor UCLA Med Ctr, Los Angeles Biomed Res Inst, Torrance, CA 90509 USA
[3] SUNY Buffalo, Buffalo, NY 14260 USA
[4] Univ Calif Davis, Med Ctr, Sacramento, CA 95817 USA
[5] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA
[6] Univ Arizona, Tucson, AZ USA
[7] Univ Tennessee, Ctr Hlth Sci, Memphis, TN 38163 USA
[8] Univ Miami, Miami, FL USA
[9] Ohio State Univ, Coll Med, Columbus, OH 43210 USA
[10] Harvard Univ, Brigham & Womens Hosp, Sch Med, Boston, MA 02115 USA
关键词
BREAST-CANCER; POSTMENOPAUSAL WOMEN; NEOADJUVANT CHEMOTHERAPY; VERTEBRAL DEFORMITIES; MAMMOGRAPHIC DENSITY; CLINICAL-TRIAL; MAMMARY-GLAND; RISK; FRACTURES; MORTALITY;
D O I
10.1089/jwh.2013.4270
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: Clinical outcomes of the Women's Health Initiative (WHI) calcium plus vitamin D supplementation trial have been reported during 7.0 years of active intervention. We now report outcomes 4.9 years after the intervention stopped and cumulative findings. Methods: Postmenopausal women (N=36,282) were randomized; postintervention follow-up continued among 29,862 (86%) of surviving participants. Primary outcomes were hip fracture and colorectal cancer. Breast cancer, all cancers, cardiovascular disease (CVD), and total mortality were predetermined major study outcomes. Results: Hip fracture incidence was comparable in the supplement and the placebo groups, postintervention hazard ratio (HR)=0.95, 95% confidence interval (95% CI: 0.78, 1.15) and overall HR=0.91 (95% CI: 0.79, 1.05). Overall, colorectal cancer incidence did not differ between randomization groups, HR=0.95 (95% CI: 0.80, 1.13). Throughout, there also was no difference in invasive breast cancer, CVD, and all-cause mortality between groups. In subgroup analyses, the invasive breast cancer effect varied by baseline vitamin D intake (p=0.03 for interaction). Women with vitamin D intakes >600IU/d, had an increased risk of invasive breast cancer, HR=1.28 (95% CI; 1.03, 1.60). Over the entire study period, in post hoc analyses, the incidence of vertebral fractures, HR=0.87 (95% CI: 0.76, 0.98) and in situ breast cancers, HR=0.82 (95% CI: 0.68, 0.99) were lower among women randomized to supplementation. Conclusion: After an average of 11 years, calcium and vitamin D supplementation did not decrease hip fracture or colorectal cancer incidence. Exploratory analyses found lower vertebral fracture and in situ breast cancer incidence in the supplement users. There was no effect on CVD or all-cause mortality.
引用
收藏
页码:915 / 929
页数:15
相关论文
共 39 条
  • [1] Effects of conjugated, equine estrogen in postmenopausal women with hysterectomy - The women's health initiative randomized controlled trial
    Anderson, GL
    Limacher, M
    Assaf, AR
    Bassford, T
    Beresford, SAA
    Black, H
    Bonds, D
    Brunner, R
    Brzyski, R
    Caan, B
    Chlebowski, R
    Curb, D
    Gass, M
    Hays, J
    Heiss, G
    Hendrix, S
    Howard, BV
    Hsia, J
    Hubbell, A
    Jackson, R
    Johnson, KC
    Judd, H
    Kotchen, JM
    Kuller, L
    LaCroix, AZ
    Lane, D
    Langer, RD
    Lasser, N
    Lewis, CE
    Manson, J
    Margolis, K
    Ockene, J
    O'Sullivan, MJ
    Phillips, L
    Prentice, RL
    Ritenbaugh, C
    Robbins, J
    Rossouw, JE
    Sarto, G
    Stefanick, ML
    Van Horn, L
    Wactawski-Wende, J
    Wallace, R
    Wassertheil-Smoller, S
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2004, 291 (14): : 1701 - 1712
  • [2] Vitamin D and Calcium Supplementation and One-Year Change in Mammographic Density in the Women's Health Initiative Calcium and Vitamin D Trial
    Bertone-Johnson, Elizabeth R.
    McTiernan, Anne
    Thomson, Cynthia A.
    Wactawski-Wende, Jean
    Aragaki, Aaron K.
    Rohan, Thomas E.
    Vitolins, Mara Z.
    Tamimi, Rulla M.
    Johnson, Karen C.
    Lane, Dorothy
    Rexrode, Kathryn M.
    Peck, Jennifer D.
    Chlebowski, Rowan T.
    Sarto, Gloria
    Manson, JoAnn E.
    [J]. CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION, 2012, 21 (03) : 462 - 473
  • [3] Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures
    Black, DM
    Arden, NK
    Palermo, L
    Pearson, J
    Cummings, SR
    [J]. JOURNAL OF BONE AND MINERAL RESEARCH, 1999, 14 (05) : 821 - 828
  • [4] Vitamin D insufficiency and health outcomes over 5 y in older women
    Bolland, Mark J.
    Bacon, Catherine J.
    Horne, Anne M.
    Mason, Barbara H.
    Ames, Ruth W.
    Wang, Tom K. M.
    Grey, Andrew B.
    Gamble, Greg D.
    Reid, Ian R.
    [J]. AMERICAN JOURNAL OF CLINICAL NUTRITION, 2010, 91 (01) : 82 - 89
  • [5] The Effect of Calcium plus Vitamin D on Risk for Invasive Cancer: Results of the Women's Health Initiative (WHI) Calcium Plus Vitamin D Randomized Clinical Trial
    Brunner, Robert L.
    Wactawski-Wende, Jean
    Caan, Bette J.
    Cochrane, Barbara B.
    Chlebowski, Rowan T.
    Gass, Margery L. S.
    Jacobs, Elizabeth T.
    LaCroix, Andrea Z.
    Lane, Dorothy
    Larson, Joseph
    Margolis, Karen L.
    Millen, Amy E.
    Sarto, Gloria E.
    Vitolins, Mara Z.
    Wallace, Robert B.
    [J]. NUTRITION AND CANCER-AN INTERNATIONAL JOURNAL, 2011, 63 (06): : 827 - 841
  • [6] Risk of mortality following clinical fractures
    Cauley, JA
    Thompson, DE
    Ensrud, KC
    Scott, JC
    Black, D
    [J]. OSTEOPOROSIS INTERNATIONAL, 2000, 11 (07) : 556 - 561
  • [7] Validity of self-report for fractures among a multiethnic cohort of postmenopausal women: results from the Women's Health Initiative observational study and clinical trials
    Chen, Z
    Kooperberg, C
    Pettinger, MB
    Bassford, T
    Cauley, JA
    LaCroix, AZ
    Lewis, CE
    Kipersztok, S
    Borne, C
    Jackson, RD
    [J]. MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY, 2004, 11 (03): : 264 - 274
  • [8] Estrogen plus progestin and breast cancer detection by means of mammography and breast biopsy
    Chlebowski, Rowan T.
    Anderson, Garnet
    Pettinger, Mary
    Lane, Dorothy
    Langer, Robert D.
    Gillian, Mary Ann
    Walsh, Brian W.
    Chen, Chu
    McTiernan, Anne
    [J]. ARCHIVES OF INTERNAL MEDICINE, 2008, 168 (04) : 370 - 377
  • [9] Calcium Plus Vitamin D Supplementation and the Risk of Breast Cancer
    Chlebowski, Rowan T.
    Johnson, Karen C.
    Kooperberg, Charles
    Pettinger, Mary
    Wactawski-Wende, Jean
    Rohan, Tom
    Rossouw, Jacques
    Lane, Dorothy
    O'Sullivan, Mary Jo
    Yasmeen, Shagufta
    Hiatt, Robert A.
    Shikany, James M.
    Vitolins, Mara
    Khandekar, Janu
    Hubbell, F. Allan
    [J]. JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2008, 100 (22): : 1581 - 1591
  • [10] Biomechanics of vertebral fractures and the vertebral fracture cascade
    Christiansen B.A.
    Bouxsein M.L.
    [J]. Current Osteoporosis Reports, 2010, 8 (4) : 198 - 204