Open Access Highly Accessed Research article

The influence of calcium and magnesium in drinking water and diet on cardiovascular risk factors in individuals living in hard and soft water areas with differences in cardiovascular mortality

Christina Nerbrand1*, Lars Agréus2, Ragnhild Arvidsson Lenner3, Per Nyberg4 and Kurt Svärdsudd5

Author Affiliations

1 Primary Care R&D, Department of Medicine, University of Lund, SE-221 85 Lund, Sweden

2 Family Medicine Stockholm, Karolinska Institutet, Stockholm, SE-141 57 Huddinge, Sweden

3 Department of Clinical Nutrition, Sahlgrenska Academy at Göteborgs University, SE-413 45 Göteborg, Sweden

4 Primary Care R&D, Department of Caring Sciences, University of Lund, SE-221 85 Lund, Sweden

5 Department of Public Health and Caring Science, Section of Family Medicine, University of Uppsala, SE-751 85 Uppsala, Sweden

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BMC Public Health 2003, 3:21  doi:10.1186/1471-2458-3-21

Published: 18 June 2003



The role of water hardness as a risk factor for cardiovascular disease has been widely investigated and evaluated as regards regional differences in cardiovascular disease. This study was performed to evaluate the relation between calcium and magnesium in drinking water and diet and risk factors for cardiovascular disease in individuals living in hard and soft water areas with considerable differences in cardiovascular mortality.


A random sample of 207 individuals living in two municipalities characterised by differences in cardiovascular mortality and water hardness was invited for an examination including a questionnaire about health, social and living conditions and diet. Intake of magnesium and calcium was calculated from the diet questionnaire with special consideration to the use of local water. Household water samples were delivered by each individual and were analysed for magnesium and calcium.


In the total sample, there were positive correlations between the calcium content in household water and systolic blood pressure (SBP) and negative correlations with s-cholesterol and s-LDL-cholesterol. No correlation was seen with magnesium content in household water to any of the risk factors.

Calcium content in diet showed no correlation to cardiovascular risk factors. Magnesium in diet was positively correlated to diastolic blood pressure (DBP). In regression analyses controlled for age and sex 18.5% of the variation in SBP was explained by the variation in BMI, HbA1c and calcium content in water. Some 27.9% of the variation in s-cholesterol could be explained by the variation in s-triglycerides (TG), and calcium content in water.


This study of individuals living in soft and hard water areas showed significant correlations between the content of calcium in water and major cardiovascular risk factors. This was not found for magnesium in water or calcium or magnesium in diet. Regression analyses indicated that calcium content in water could be a factor in the complexity of relationships and importance of cardiovascular risk factors. From these results it is not possible to conclude any definite causal relation and further research is needed.