The authors defend very carefully their observation that calcium supplements increase cardiovascular risk and discuss the hypothetical mechanisms. As calcium prescribers, one might be tempted to accept this notion, safe in the knowledge that calcium from nutrients is harmless and therefore preferable. However, patients rarely consume the recommended amount of calcium with their food, and for this reason, we should examine carefully the claim for harmful effects of calcium supplements. Without discussing the methodical PF-02341066 order aspects of the two studies—the authors of the manuscript in this
issue do this extensively—a few considerations allow us to question their practical significance. First, we are entitled to retain from these publications only those results which were statistically significant. Data which are not significant should not be over interpreted. They can be noted as a trend, which should be considered—by definition—as not meaningful, not indicative and not notable, unless the lack of significance is taken as a message in
itself. This then excludes the increased risk of stroke and sudden death, which are reported as adverse effects of calcium supplements, and leaves us with the risk of myocardial infarction (MI) as the only significant negative event of calcium supplementation. BAY 73-4506 The significance stems from a meta-analysis [5]. In the previous trial from the same authors [4], the risk of MI was no longer significantly increased once the data had undergone a quality control FAD audit using the national database of hospital
admissions. The meta-analysis of 15 trials demonstrated a significant increase of the risk of MI induced by calcium supplements, although none of the studies analysed individually resulted in significant results, even not the largest one. In the hierarchy of evidences, the Centre for Evidence-Based Medicine, Oxford, UK puts a meta-analysis with homogenous outcomes above the level of evidence provided by a randomized controlled trial (RCT), but this implies that the outcomes are primary or secondary, and not—as here in many cases—retrospectively defined outcomes. For this reason, this study is not a {Selleck Anti-diabetic Compound Library|Selleck Antidiabetic Compound Library|Selleck Anti-diabetic Compound Library|Selleck Antidiabetic Compound Library|Selleckchem Anti-diabetic Compound Library|Selleckchem Antidiabetic Compound Library|Selleckchem Anti-diabetic Compound Library|Selleckchem Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|Anti-diabetic Compound Library|Antidiabetic Compound Library|buy Anti-diabetic Compound Library|Anti-diabetic Compound Library ic50|Anti-diabetic Compound Library price|Anti-diabetic Compound Library cost|Anti-diabetic Compound Library solubility dmso|Anti-diabetic Compound Library purchase|Anti-diabetic Compound Library manufacturer|Anti-diabetic Compound Library research buy|Anti-diabetic Compound Library order|Anti-diabetic Compound Library mouse|Anti-diabetic Compound Library chemical structure|Anti-diabetic Compound Library mw|Anti-diabetic Compound Library molecular weight|Anti-diabetic Compound Library datasheet|Anti-diabetic Compound Library supplier|Anti-diabetic Compound Library in vitro|Anti-diabetic Compound Library cell line|Anti-diabetic Compound Library concentration|Anti-diabetic Compound Library nmr|Anti-diabetic Compound Library in vivo|Anti-diabetic Compound Library clinical trial|Anti-diabetic Compound Library cell assay|Anti-diabetic Compound Library screening|Anti-diabetic Compound Library high throughput|buy Antidiabetic Compound Library|Antidiabetic Compound Library ic50|Antidiabetic Compound Library price|Antidiabetic Compound Library cost|Antidiabetic Compound Library solubility dmso|Antidiabetic Compound Library purchase|Antidiabetic Compound Library manufacturer|Antidiabetic Compound Library research buy|Antidiabetic Compound Library order|Antidiabetic Compound Library chemical structure|Antidiabetic Compound Library datasheet|Antidiabetic Compound Library supplier|Antidiabetic Compound Library in vitro|Antidiabetic Compound Library cell line|Antidiabetic Compound Library concentration|Antidiabetic Compound Library clinical trial|Antidiabetic Compound Library cell assay|Antidiabetic Compound Library screening|Antidiabetic Compound Library high throughput|Anti-diabetic Compound high throughput screening| conventional meta-analysis. Some critics call it a ‘review of published trials’ [6]. This leads to the following question: will a well-powered RCT with cardiovascular events as primary outcomes not have a comparable weight of evidence? According to Reid and colleagues [3], such trials cannot be envisaged for reasons of practicality and ethical obstacles. But there is one such study, and it showed no negative cardiovascular effects [7]. Even accepting the result of this “meta-analysis”, we still should remember its context—namely, in the prevention of osteoporosis.