{"id":"de04b9c1-4e11-5a80-af22-011e916924c0","stable_key":"434e1e27-eb90-583a-956b-62472726ffba:cal-bolland-myocardial-events","predicate":"has_reported_effect_on","statement":"An older-women calcium trial showed an upward myocardial-infarction signal that weakened when registry events were added.","claim_class":"observational","status":"source_derived_draft","evidence_grade":"ungraded","direction":"context_dependent","is_public":true,"mechanism_event_id":"873954e4-0c99-548b-bec8-2d19b71f2dfb","mechanism_event_label":"The heart-event result depended partly on how events were collected.","subject":{"id":"8e2a5a1f-cd49-5f28-8611-325266fb78a6","slug":"calcium","display_name":"Calcium","entity_type_key":"nutrient_element"},"object":{"id":"5f1e43f5-d01f-500d-8c59-1cd66faa7c77","slug":"myocardial-infarction-incidence","display_name":"Myocardial infarction incidence","entity_type_key":"cellular_process"},"evidence_count":1,"mechanism_event":{"id":"873954e4-0c99-548b-bec8-2d19b71f2dfb","stable_key":"434e1e27-eb90-583a-956b-62472726ffba:cal-bolland-myocardial-events-event","event_type":"observed_intervention","label":"The heart-event result depended partly on how events were collected.","description":"An older-women calcium trial showed an upward myocardial-infarction signal that weakened when registry events were added.","status":"provisional","compartment":null,"participants":[{"entity":{"id":"8e2a5a1f-cd49-5f28-8611-325266fb78a6","slug":"calcium","display_name":"Calcium","entity_type_key":"nutrient_element"},"role":"tested_input","stoichiometry":null,"state_label":"","sequence_order":0,"notes":""},{"entity":{"id":"5f1e43f5-d01f-500d-8c59-1cd66faa7c77","slug":"myocardial-infarction-incidence","display_name":"Myocardial infarction incidence","entity_type_key":"cellular_process"},"role":"measured_outcome","stoichiometry":null,"state_label":"","sequence_order":1,"notes":""},{"entity":{"id":"a04ab5be-287a-52ff-a503-ed77277772bb","slug":"calcium-citrate","display_name":"Calcium citrate","entity_type_key":"chemical_species"},"role":"calcium_form","stoichiometry":null,"state_label":"","sequence_order":2,"notes":""}]},"contexts":[{"dimension":"experimental_model","value_text":"1471 postmenopausal women, five-year randomized trial; secondary cardiovascular analysis.","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"exposure","value_text":"Calcium citrate tablets versus placebo in the parent randomized trial; calcium-only intervention, not the WHI calcium-plus-vitamin-D regimen.","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"limitations","value_text":"Adjudicated reported MI RR 2.12 (1.01-4.47); including unreported registry events RR 1.49 (0.86-2.57). Does not establish vascular calcification as the mediator.","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"nutrient_topic","value_text":"Calcium research collection; topical membership is not evidence of a direct dietary effect.","comparator":null,"unit":null,"notes":"","entity":{"slug":"calcium","display_name":"Calcium","entity_type_key":"nutrient_element"}},{"dimension":"organism","value_text":"Homo sapiens","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"plain_language","value_text":"The heart-event result depended partly on how events were collected.","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"primary_references","value_text":"[cal-clin-bolland2008] Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial (2008). https://pubmed.ncbi.nlm.nih.gov/18198394/ DOI: 10.1136/bmj.39440.525752.BE","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"tissue_or_cell_type","value_text":"Human clinical or absorption endpoint","comparator":null,"unit":null,"notes":"","entity":null}],"evidence":[{"id":"23f17b56-5c1a-5c82-a26b-34e3d61974a6","evidence_kind":"source_excerpt","locator":"Lines 1281-1291","start_line":1281,"end_line":1291,"excerpt":"### cal-bolland-myocardial-events\nAn older-women calcium trial showed an upward myocardial-infarction signal that weakened when registry events were added.\nCondition category: normal\nnutrient_topic: Calcium research collection; topical membership is not evidence of a direct dietary effect.\nplain_language: The heart-event result depended partly on how events were collected.\norganism: Homo sapiens\ntissue_or_cell_type: Human clinical or absorption endpoint\nexperimental_model: 1471 postmenopausal women, five-year randomized trial; secondary cardiovascular analysis.\nlimitations: Adjudicated reported MI RR 2.12 (1.01-4.47); including unreported registry events RR 1.49 (0.86-2.57). Does not establish vascular calcification as the mediator.\nexposure: Calcium citrate tablets versus placebo in the parent randomized trial; calcium-only intervention, not the WHI calcium-plus-vitamin-D regimen.\n[cal-clin-bolland2008] Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial (2008). https://pubmed.ncbi.nlm.nih.gov/18198394/ DOI: 10.1136/bmj.39440.525752.BE","model_system":"1471 postmenopausal women, five-year randomized trial; secondary cardiovascular analysis.","directness":"author_interpretation","verification_status":"source_derived_draft","notes":"Exact curation-document quotation, not publisher quotation. Study references: [cal-clin-bolland2008] Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial (2008). https://pubmed.ncbi.nlm.nih.gov/18198394/ DOI: 10.1136/bmj.39440.525752.BE","relationship":"supports","weight":1.0,"link_notes":"","source":{"id":"3c083fa0-59c6-50e9-af42-678d0e3c1006","stable_key":"import-434e1e27-eb90-583a-956b-62472726ffba","title":"Calcium: mechanism-first literature curation (2026-09-17)","document_type":"imported_text","citation_label":"AI-assisted literature curation; primary study URLs and scope retained in the document and extraction. Not publisher full text.","file_path":"","sha256":"965c934d6b147f2b62f8d45ce6d7a87681a600bfe5c46a585b4704889afd3fc1","revision_id":"543ec48b-4f70-5197-9d76-f5a3c443664c","review_status":"unverified_draft","notes":""}}],"relations":[],"conflicts":[{"id":"cadfc3f9-a933-544f-95be-ba4c602533ec","title":"Cardiovascular findings vary by trial and event ascertainment","kind":"context_difference","status":"open","why":"The calcium-only signal weakened with registry ascertainment, while WHI tested calcium plus vitamin D and a different endpoint. Neither supplies a universal risk estimate or proves coronary calcification as mechanism.","resolution":"Unresolved; needs review.","created_at":"2026-09-17 08:08:54","record_type":"conflict","display_label":"Recorded conflict","record_url":"/conflicts/cadfc3f9-a933-544f-95be-ba4c602533ec","sides":[{"conflict_id":"cadfc3f9-a933-544f-95be-ba4c602533ec","ordinal":0,"label":"The heart-event result depended partly on how events were collected.","revision_id":"543ec48b-4f70-5197-9d76-f5a3c443664c","start_line":1281,"end_line":1291,"quote":"### cal-bolland-myocardial-events\nAn older-women calcium trial showed an upward myocardial-infarction signal that weakened when registry events were added.\nCondition category: normal\nnutrient_topic: Calcium research collection; topical membership is not evidence of a direct dietary effect.\nplain_language: The heart-event result depended partly on how events were collected.\norganism: Homo sapiens\ntissue_or_cell_type: Human clinical or absorption endpoint\nexperimental_model: 1471 postmenopausal women, five-year randomized trial; secondary cardiovascular analysis.\nlimitations: Adjudicated reported MI RR 2.12 (1.01-4.47); including unreported registry events RR 1.49 (0.86-2.57). Does not establish vascular calcification as the mediator.\nexposure: Calcium citrate tablets versus placebo in the parent randomized trial; calcium-only intervention, not the WHI calcium-plus-vitamin-D regimen.\n[cal-clin-bolland2008] Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial (2008). https://pubmed.ncbi.nlm.nih.gov/18198394/ DOI: 10.1136/bmj.39440.525752.BE","source_key":"import-434e1e27-eb90-583a-956b-62472726ffba","source_title":"Calcium: mechanism-first literature curation (2026-09-17)","claim_ids":["de04b9c1-4e11-5a80-af22-011e916924c0"]},{"conflict_id":"cadfc3f9-a933-544f-95be-ba4c602533ec","ordinal":1,"label":"This trial did not reproduce a clear increase in coronary events.","revision_id":"543ec48b-4f70-5197-9d76-f5a3c443664c","start_line":1293,"end_line":1303,"quote":"### cal-whi-coronary-events\nWHI found no significant effect of calcium plus vitamin D on myocardial infarction or coronary death.\nCondition category: normal\nnutrient_topic: Calcium research collection; topical membership is not evidence of a direct dietary effect.\nplain_language: This trial did not reproduce a clear increase in coronary events.\norganism: Homo sapiens\ntissue_or_cell_type: Human clinical or absorption endpoint\nexperimental_model: Prespecified secondary WHI outcome; seven years.\nlimitations: Different cointervention, participants and ascertainment from the calcium-only trial; absence of significance does not prove universal safety.\nexposure: MI/coronary-death HR 1.04, 95% CI 0.92-1.18.\n[cal-clin-hsia2007] Calcium/vitamin D supplementation and cardiovascular events (2007). https://pubmed.ncbi.nlm.nih.gov/17309935/ DOI: 10.1161/CIRCULATIONAHA.106.673491","source_key":"import-434e1e27-eb90-583a-956b-62472726ffba","source_title":"Calcium: mechanism-first literature curation (2026-09-17)","claim_ids":["c6d6da6a-1a36-5ee3-85df-7f4187ac0a8e"]}]}],"corrections":[],"research":null}