The case for dietary calcium restriction in patients with atherosclerosis

An increasingly vast set of data is linking the process of vascular calcification to the metabolism of calcium and phosphorus. This phenomenon is already relatively well understood in renal failure patients. A similar phenomenon, however, could be taking place in the general population. This may indicate a need for a reassessment of calcium supplementation, including the ingestion of milk, not only in dialysis patients, but also in patients with preserved renal function. Given the fact that no clear prospective randomized evidence exists to show what may be the impact on prognosis of patients with atherosclerosis, caused by the ingestion of milk and milk derivatives, containing calcium and lactose, as is currently recommended to prevent bone disease in the general population, a case could be made to recommend restriction of such dietary products in atherosclerosis patients, until precise data have been obtained, in controlled, prospective studies, and especially so in patients with no evidence of osteoporosis. Such a case would not be a strong one at the present stage, but neither would be the opposite view. The recommendation that could be made at this stage would be that patients with significant atherosclerotic disease should be informed that the ingestion of milk, and calcium supplementation in general, has neither been conclusively proven to be safe, nor the opposite.