Coffee consumption and risk of heart failure in men: an analysis from the Cohort of Swedish Men

Prognostic cardiovascular cut-off values of dietary caffeine in a cohort of unselected men and women from general population

BACKGROUND AND AIMS

Among an unselected cohort of men and women from general population (n = 1.668), the prognostic effects of being over the cut-off of all-source dietary caffeine intake were studied.

METHODS AND RESULTS

Prognostic cut-off values for coronary events, incident heart failure (HF), cerebrovascular events (CBV) and arrhythmic events (ARR) were found by means of the receiver-operating-characteristic curves method. Those for HF (>230 mg/day), for CBV (>280 mg/day) and for ARR (>280 mg/day) were confirmed in multivariate Cox analysis adjusted for age, body mass index, circulating thyroid hormone, diabetes mellitus, arterial hypertension, smoking, dietary intake of ethanol, basal heart rate, low-density-lipoprotein cholesterol, forced expiratory volume in 1 s and β-blocking therapy. Being over these cut-off values was associated to a reduced hazard ratio during the follow-up in the whole cohort (HR 0.678, 95%CI 0.567-0.908, p = 0.009 for HF; 0.651, 95%CI 0.428-0.994, p = 0.018 for CBV; 0.395, 95%CI 0.395-0.933, p = 0.022 for ARR) and in men (0.652, 0.442-0.961, p = 0.029; 0.432, 0.201-0.927, p = 0.03; 0.553, 0.302-1.000, p = 0.05, respectively) but not in women. The caffeine-induced risk decrease observed in the whole cohort is therefore entirely attributable to men. In the case of HF, heart rate entered the risk equation in a positive manner without rejecting caffeine. The -163C>A polymorphism of the CYP1A2 gene, codifying for ability to metabolize caffeine, introduced in sensitivity analysis, did not alter the prognostic models.

CONCLUSION

Men introducing >230 mg/day caffeine show a reduced risk of HF, and those introducing >280 mg/day a reduced risk of CBV and ARR independent of genetic pattern.

Effect of Coffee Consumption on Risk of Coronary Heart Disease in a Systematic Review and Meta-Analysis of Prospective Cohort Studies

Previous prospective studies have reported inconsistent findings on the association between coffee consumption and the risk of coronary heart disease (CHD). This study aimed to investigate their association using a meta-analysis of prospective studies. We searched PubMed and EMBASE for prospective cohort studies of the association between coffee consumption and the risk of CHD in the general population. We conducted a random-effects meta-analysis and also subgroup meta-analyses by various factors. Of 870 studies searched from databases, 32 prospective cohort studies were included in the final analysis. In the main meta-analysis of all studies, no significant association between coffee consumption and the risk of CHD was observed (relative risk [RR] 1.05, 95% confidence interval [CI] 0.97 to 1.14, I² = 64.9%). In the subgroup meta-analyses by gender, coffee consumption significantly increased the risk of CHD in men (RR 1.19, 95% CI 1.05 to 1.35, n = 17), whereas a nonsignificantly decreased risk of CHD was observed in women (RR 0.91, 95% CI 0.77 to 1.08, n = 11). Also, in the subgroup meta-analyses by follow-up period, coffee consumption significantly increased the risk of CHD in the follow-up of 20 years or longer (RR 1.16, 95% CI 1.06 to 1.27, n = 4) regardless of gender. In conclusion, in the current meta-analysis of prospective studies, we found that, overall, no significant association between coffee consumption and the risk of CHD was observed. However, coffee consumption showed a differential effect by gender, with an increased risk of CHD in men and a potentially decreased risk in women.

Coffee and tea consumption in the early adult lifespan and left ventricular function in middle age: the CARDIA study

Aims

The long‐term impact of coffee or tea consumption on subclinical left ventricular (LV) systolic or diastolic function has not been previously studied. We examined the association between coffee or tea consumption beginning in early adulthood and cardiac function in midlife.

Methods and results

We investigated 2735 Coronary Artery Risk Development in Young Adults (CARDIA) study participants with long‐term total caffeine intake, coffee, and tea consumption data from three visits over a 20 year interval and available echocardiography indices at the CARDIA Year‐25 exam (2010–2011). Linear regression models were used to assess the association between caffeine intake, tea, and coffee consumption (independent variables) and echocardiography outcomes [LV mass, left atrial volume, and global longitudinal strain (GLS), LV ejection fraction (LVEF), and transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e´)]. Models were adjusted for standard cardiovascular risk factors, socioeconomic status, physical activity, alcohol use, and dietary factors (calorie intake, whole and refined grain intake, and fruit and vegetable consumption). Mean (standard deviation) age was 25.2 (3.5) years at the CARDIA Year‐0 exam (1985–1986), 57.4% were women, and 41.9% were African‐American. In adjusted multivariable linear regression models assessing the relationship between coffee consumption and GLS, beta coefficients when comparing coffee drinkers of <1, 1–2, 3–4, and >4 cups/day with non‐coffee drinkers were β = −0.30%, P < 0.05; β = −0.35%, P < 0.05; β = −0.32%, P < 0.05; β = −0.40%, P > 0.05; respectively (more negative values implies better systolic function). In adjusted multivariable linear regression models assessing the relationship between coffee consumption and E/e´, beta coefficients when comparing coffee drinkers of <1, 1–2, 3–4, and >4 cups/day with non‐coffee drinkers were β = −0.29, P < 0.05; β = −0.38, P < 0.01; β = −0.20, P > .05; and β = −0.37, P > 0.05, respectively (more negative values implies better diastolic function). High daily coffee consumption (>4 cups/day) was associated with worse LVEF (β = −1.69, P < 0.05). There were no associations between either tea drinking or total caffeine intake and cardiac function (P > 0.05 for all).

Conclusions

Low‐to‐moderate daily coffee consumption from early adulthood to middle age was associated with better LV systolic and diastolic function in midlife. High daily coffee consumption (>4cups/day) was associated with worse LV function. There was no association between caffeine or tea intake and cardiac function.

Dietary Research on Coffee: Improving Adjustment for Confounding

Meta-analyses have reported higher levels of coffee consumption to be associated with lower mortality. In contrast, some systematic reviews have linked coffee consumption to increased risks for lung cancer and hypertension. Given these inconsistencies, this narrative review critically evaluated the methods and analyses of cohort studies investigating coffee and mortality. A specific focus was adjustment for confounding related to smoking, healthy and unhealthy foods, and alcohol. Assessment of 36 cohort samples showed that many did not adequately adjust for smoking. Consuming 1-5 cups of coffee per day was related to lower mortality among never smokers, in studies that adjusted for pack-years of smoking, and in studies adjusting for healthy and unhealthy foods. Possible reduced health benefits for coffee with added sugar have not been adequately investigated. Research on coffee and health should report separate analyses for never smokers, adjust for consumption of healthy and unhealthy foods, and for sugar added to coffee.

The effect of diet, lifestyle and psychological factors in the prognosis of ischemic heart failure

Background/Objective

Dietary patterns may play an important role in the prognosis of heart failure.

Methods

Dietary habits, sleeping habits, physical activity and anxiety and depression status were recorded in 326 patients (90 females, mean age 73.45 ± 10.9 years) with ischemic heart failure prospectively followed for 30 months.

Results

Lower ΗADS-depression scores (p = 0.03), a low-fat meat diet (p = 0.035) and moderate coffee consumption (p = 0.005) were associated with better prognosis. Non-significant differences were recorded in outcomes with regard to consumption of other dietary categories.

Conclusions

A balanced diet as well as emphasis on the treatment of depression may improve outcomes in ischemic heart failure.

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Coffee consumption is associated with better outcomes in ischemic heart failure.

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A low fat meat diet is associated with better outcomes in ischemic heart failure.

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High ΗADS depression score is related to worst prognosis in ischemic heart failure.

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Sedentary lifestyle is related to worst outcomes in ischemic heart failure.

Coffee consumption and risk of all-cause, cardiovascular, and cancer mortality in smokers and non-smokers: a dose-response meta-analysis

Coffee consumption has been associated with several benefits toward human health. However, its association with mortality risk has yielded contrasting results, including a non-linear relation to all-cause and cardiovascular disease (CVD) mortality and no association with cancer mortality. As smoking habits may affect the association between coffee and health outcomes, the aim of the present study was to update the latest dose-response meta-analysis of prospective cohort studies on the association between coffee consumption and mortality risk and conduct stratified analyses by smoking status and other potential confounders. A systematic search was conducted in electronic databases to identify relevant studies, risk estimates were retrieved from the studies, and dose-response analysis was modeled by using restricted cubic splines. A total of 31 studies comprising 1610,543 individuals and 183,991 cases of all-cause, 34,574 of CVD, and 40,991 of cancer deaths were selected. Analysis showed decreased all-cause [relative risk (RR) = 0.86, 95 % confidence interval (CI) = 0.82, 0.89)] and CVD mortality risk (RR = 0.85, 95 % CI = 0.77, 0.93) for consumption of up to 4 cups/day of coffee, while higher intakes were associated with no further lower risk. When analyses were restricted only to non-smokers, a linear decreased risk of all-cause (RR = 0.94, 95 % CI = 0.93, 0.96), CVD (RR = 0.94, 95 % CI = 0.91, 0.97), and cancer mortality (RR = 0.98, 95 % CI = 0.96, 1.00) for 1 cup/day increase was found. The search for other potential confounders, including dose-response analyses in subgroups by gender, geographical area, year of publication, and type of coffee, showed no relevant differences between strata. In conclusion, coffee consumption is associated with decreased risk of mortality from all-cause, CVD, and cancer; however, smoking modifies the observed risk when studying the role of coffee on human health.

Coffee consumption and mortality in three Eastern European countries: results from the HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study

OBJECTIVE

To test the association between coffee consumption and risk of all-cause, CVD and cancer death in a European cohort.

DESIGN

Prospective cohort study. Cox proportional hazards models with adjustment for potential confounders to estimate multivariable hazard ratios (HR) and 95 % CI were used.

SETTING

Czech Republic, Russia and Poland.

SUBJECTS

A total of 28561 individuals followed for 6·1 years.

RESULTS

A total of 2121 deaths (43·1 % CVD and 35·7 % cancer mortality) occurred during the follow-up. Consumption of 3-4 cups coffee/d was associated with lower mortality risk in men (HR=0·83; 95 % CI 0·71, 0·99) and women (HR=0·63; 95 % CI 0·47, 0·84), while further intake showed non-significant reduced risk estimates (HR=0·71; 95 % CI 0·49, 1·04 and HR=0·51; 95 % CI 0·24, 1·10 in men and women, respectively). Decreased risk of CVD mortality was also found in men (HR=0·71; 95 % CI 0·54, 0·93) for consumption of 3-4 cups coffee/d. Stratified analysis revealed that consumption of a similar amount of coffee was associated with decreased risk of all-cause (HR=0·61; 95 % CI 0·43, 0·87) and cancer mortality (HR=0·59; 95 % CI 0·35, 0·99) in non-smoking women and decreased risk of all-cause mortality for >4 cups coffee/d in men with no/moderate alcohol intake.

CONCLUSIONS

Coffee consumption was associated with decreased risk of mortality. The protective effect was even stronger when stratification by smoking status and alcohol intake was performed.

Coffee consumption and mortality from all causes, cardiovascular disease, and cancer: a dose-response meta-analysis

Several studies have analyzed the relationship between coffee consumption and mortality, but the shape of the association remains unclear. We conducted a dose-response meta-analysis of prospective studies to examine the dose-response associations between coffee consumption and mortality from all causes, cardiovascular disease (CVD), and all cancers. Pertinent studies, published between 1966 and 2013, were identified by searching PubMed and by reviewing the reference lists of the selected articles. Prospective studies in which investigators reported relative risks of mortality from all causes, CVD, and all cancers for 3 or more categories of coffee consumption were eligible. Results from individual studies were pooled using a random-effects model. Twenty-one prospective studies, with 121,915 deaths and 997,464 participants, met the inclusion criteria. There was strong evidence of nonlinear associations between coffee consumption and mortality for all causes and CVD (P for nonlinearity < 0.001). The largest risk reductions were observed for 4 cups/day for all-cause mortality (16%, 95% confidence interval: 13, 18) and 3 cups/day for CVD mortality (21%, 95% confidence interval: 16, 26). Coffee consumption was not associated with cancer mortality. Findings from this meta-analysis indicate that coffee consumption is inversely associated with all-cause and CVD mortality.

Association of coffee drinking with all-cause mortality: a systematic review and meta-analysis

OBJECTIVE

We aimed to use the meta-analysis method to assess the relationship between coffee drinking and all-cause mortality.

DESIGN

Categorical and dose-response meta-analyses were conducted using random-effects models.

SETTING

We systematically searched and identified eligible literature in the PubMed and Scopus databases.

SUBJECTS

Seventeen studies including 1 054 571 participants and 131 212 death events from all causes were included in the present study.

RESULTS

Seventeen studies were included and evaluated in the meta-analysis. A U-shaped dose-response relationship was found between coffee consumption and all-cause mortality (P for non-linearity <0.001). Compared with non/occasional coffee drinkers, the relative risks for all-cause mortality were 0.89 (95 % CI 0.85, 0.93) for 1-<3 cups/d, 0.87 (95 % CI 0.83, 0.91) for 3-<5 cups/d and 0.90 (95 % CI 0.87, 0.94) for ≥5 cups/d, and the relationship was more marked in females than in males.

CONCLUSIONS

The present meta-analysis of prospective cohort studies indicated that light to moderate coffee intake is associated with a reduced risk of death from all causes, particularly in women.

Long-term coffee consumption and risk of cardiovascular disease: a systematic review and a dose-response meta-analysis of prospective cohort studies

BACKGROUND

Considerable controversy exists on the association between coffee consumption and cardiovascular disease (CVD) risk. A meta-analysis was performed to assess the dose-response relationship of long-term coffee consumption with CVD risk.

METHODS AND RESULTS

PubMed and EMBASE were searched for prospective cohort studies of the relationship between coffee consumption and CVD risk, which included coronary heart disease, stroke, heart failure, and CVD mortality. Thirty-six studies were included with 1 279 804 participants and 36 352 CVD cases. A nonlinear relationship of coffee consumption with CVD risk was identified (P for heterogeneity=0.09, P for trend <0.001, P for nonlinearity <0.001). Compared with the lowest category of coffee consumption (median, 0 cups per day), the relative risk of CVD was 0.95 (95% confidence interval, 0.87-1.03) for the highest category (median, 5 cups per day) category, 0.85 (95% confidence interval, 0.80-0.90) for the second highest category (median, 3.5 cups per day), and 0.89 (95% confidence interval, 0.84-0.94) for the third highest category (median, 1.5 cups per day). Looking at separate outcomes, coffee consumption was nonlinearly associated with both coronary heart disease (P for heterogeneity=0.001, P for trend <0.001, P for nonlinearity <0.001) and stroke (P for heterogeneity=0.07, P for trend <0.001, P for nonlinearity <0.001; P for trend differences >0.05) risks.

CONCLUSIONS

A nonlinear association between coffee consumption and CVD risk was observed in this meta-analysis. Moderate coffee consumption was inversely significantly associated with CVD risk, with the lowest CVD risk at 3 to 5 cups per day, and heavy coffee consumption was not associated with elevated CVD risk.

A meta-analysis of prospective studies of coffee consumption and mortality for all causes, cancers and cardiovascular diseases

Several prospective studies considered the relation between coffee consumption and mortality. Most studies, however, were underpowered to detect an association, since they included relatively few deaths. To obtain quantitative overall estimates, we combined all published data from prospective studies on the relation of coffee with mortality for all causes, all cancers, cardiovascular disease (CVD), coronary/ischemic heart disease (CHD/IHD) and stroke. A bibliography search, updated to January 2013, was carried out in PubMed and Embase to identify prospective observational studies providing quantitative estimates on mortality from all causes, cancer, CVD, CHD/IHD or stroke in relation to coffee consumption. A systematic review and meta-analysis was conducted to estimate overall relative risks (RR) and 95 % confidence intervals (CI) using random-effects models. The pooled RRs of all cause mortality for the study-specific highest versus low (≤1 cup/day) coffee drinking categories were 0.88 (95 % CI 0.84-0.93) based on all the 23 studies, and 0.87 (95 % CI 0.82-0.93) for the 19 smoking adjusting studies. The combined RRs for CVD mortality were 0.89 (95 % CI 0.77-1.02, 17 smoking adjusting studies) for the highest versus low drinking and 0.98 (95 % CI 0.95-1.00, 16 studies) for the increment of 1 cup/day. Compared with low drinking, the RRs for the highest consumption of coffee were 0.95 (95 % CI 0.78-1.15, 12 smoking adjusting studies) for CHD/IHD, 0.95 (95 % CI 0.70-1.29, 6 studies) for stroke, and 1.03 (95 % CI 0.97-1.10, 10 studies) for all cancers. This meta-analysis provides quantitative evidence that coffee intake is inversely related to all cause and, probably, CVD mortality.

Coffee and tea consumption are inversely associated with mortality in a multiethnic urban population

Coffee and tea are commonly consumed beverages. Inverse associations with mortality have been suggested for coffee and tea, but the relationships with cause-specific mortality are not well understood. We examined regular and decaffeinated coffee and tea in relation to mortality due to all causes, vascular, nonvascular, and cancer in the multi-ethnic, prospective, population-based Northern Manhattan Study. The study population included 2461 participants with diet data who were free of stroke, myocardial infarction, and cancer at baseline (mean age 68.30 ± 10.23 y, 36% men, 19% white, 23% black, 56% Hispanic). During a mean follow-up of 11 y, we examined the associations between coffee and tea consumption, assessed by food frequency questionnaire, and 863 deaths (342 vascular related and 444 nonvascular including 160 cancer deaths) using multivariable-adjusted Cox models. Coffee consumption was inversely associated with all-cause mortality [for each additional cup/d, HR = 0.93 (95% CI: 0.88, 0.99); P = 0.02]. Caffeinated coffee was inversely associated with all-cause mortality, driven by a strong protection among those who drank ≥4 cups/d. An inverse dose-response relationship between tea and all-cause mortality was suggested [for each additional cup/d, HR = 0.91 (95% CI: 0.84, 0.99); P = 0.01]. Coffee consumption ≥4/d was protective against nonvascular death [vs. <1/mo, HR = 0.57 (95% CI: 0.33, 0.97)] and tea consumption ≥2/d was protective against nonvascular death [HR = 0.63 (95% CI: 0.41, 0.95)] and cancer [HR = 0.33 (95% CI: 0.14, 0.80)]. There was a strong inverse association between coffee and vascular-related mortality among Hispanics only. Further study is needed, including investigation into the mechanisms and compounds in coffee and tea responsible for the inverse associations with mortality. The differential relationship between coffee and vascular death across race/ethnicity underscores the need for research in similar multi-ethnic cohorts including Hispanics.

Habitual coffee consumption and risk of heart failure: a dose-response meta-analysis

BACKGROUND

There have been discrepant findings on the association between coffee consumption and risk of incident heart failure.

METHODS AND RESULTS

We conducted a systematic review and a dose-response meta-analysis of prospective studies that assessed the relationship between habitual coffee consumption and the risk of heart failure. We searched electronic databases (MEDLINE, Embase, and CINAHL) from January 1966 through December 2011, with the use of a standardized protocol. Eligible studies were prospective cohort studies that examined the association of coffee consumption with incident heart failure. Five independent prospective studies of coffee consumption and heart failure risk, including 6522 heart failure events and 140 220 participants, were included in the meta-analysis. We observed a statistically significant J-shaped relationship between coffee and heart failure. Compared with no consumption, the strongest inverse association was seen for 4 servings/day and a potentially higher risk at higher levels of consumption. There was no evidence that the relationship between coffee and heart failure risk varied by sex or by baseline history of myocardial infarction or diabetes.

CONCLUSIONS

Moderate coffee consumption is inversely associated with risk of heart failure, with the largest inverse association observed for consumption of 4 servings per day.

Coffee and its consumption: benefits and risks

Coffee is the leading worldwide beverage after water and its trade exceeds US $10 billion worldwide. Controversies regarding its benefits and risks still exist as reliable evidence is becoming available supporting its health promoting potential; however, some researchers have argued about the association of coffee consumption with cardiovascular complications and cancer insurgence. The health-promoting properties of coffee are often attributed to its rich phytochemistry, including caffeine, chlorogenic acid, caffeic acid, hydroxyhydroquinone (HHQ), etc. Many research investigations, epidemiological studies, and meta-analyses regarding coffee consumption revealed its inverse correlation with that of diabetes mellitus, various cancer lines, Parkinsonism, and Alzheimer's disease. Moreover, it ameliorates oxidative stress because of its ability to induce mRNA and protein expression, and mediates Nrf2-ARE pathway stimulation. Furthermore, caffeine and its metabolites help in proper cognitive functionality. Coffee lipid fraction containing cafestol and kahweol act as a safeguard against some malignant cells by modulating the detoxifying enzymes. On the other hand, their higher levels raise serum cholesterol, posing a possible threat to coronary health, for example, myocardial and cerebral infarction, insomnia, and cardiovascular complications. Caffeine also affects adenosine receptors and its withdrawal is accompanied with muscle fatigue and allied problems in those addicted to coffee. An array of evidence showed that pregnant women or those with postmenopausal problems should avoid excessive consumption of coffee because of its interference with oral contraceptives or postmenopausal hormones. This review article is an attempt to disseminate general information, health claims, and obviously the risk factors associated with coffee consumption to scientists, allied stakeholders, and certainly readers.

Impact of acute caffeine ingestion on endothelial function in subjects with and without coronary artery disease

Although coffee is a widely used, pharmacologically active beverage, its impact on the cardiovascular system is controversial. To explore the effect of acute caffeine ingestion on brachial artery flow-mediated dilation (FMD) in subjects without coronary artery disease (CAD; controls) and patients with CAD, we prospectively assessed brachial artery FMD in 40 controls and 40 age- and gender-matched patients with documented stable CAD on 2 separate mornings 1 week to 2 weeks apart. After overnight fasting, discontinuation of all medications for ≥12 hours, and absence of caffeine for >48 hours, participants received capsules with caffeine 200 mg or placebo. One hour after drug ingestion, participants underwent brachial artery FMD and nitroglycerin-mediated dilation (NTG) using high-resolution ultrasound. As expected, patients with CAD were more often diabetic, hypertensive, obese, dyslipidemic, and smoked more than controls (p <0.01 for all comparisons). Aspirin, Clopidogrel, angiotensin-converting enzyme inhibitors, β blockers, and statins were significantly more common in patients with CAD than in controls (p <0.01 for all comparisons). At baseline, FMD, but not NTG, was significantly lower in patients with CAD compared to controls. Acute caffeine ingestion significantly increased FMD (patients with CAD 5.6 ± 5.0% vs 14.6 ± 5.0%, controls 8.4 ± 2.9% vs 18.6 ± 6.8%, p <0.001 for all comparisons) but not NTG (patients with CAD 13.0 ± 5.2% vs 13.8 ± 6.1%, controls 12.9 ± 3.9% vs 13.9 ± 5.8%, p = NS for all comparisons) and significantly decreased high-sensitivity C-reactive protein (patients with CAD 2.6 ± 1.4 vs 1.4 ± 1.2 mg/L, controls 3.4 ± 3.0 vs 1.2 ± 1.0 mg/L, p <0.001 for all comparisons) in the 2 groups compared to placebo. In conclusion, acute caffeine ingestion significantly improved endothelial function assessed by brachial artery FMD in subjects with and without CAD and was associated with lower plasma markers of inflammation.

Coffee consumption and incidence of heart failure in women

BACKGROUND

Previous studies of the relationship between coffee consumption and incidence of heart failure (HF) have not been consistent, with both potential benefit and potential harm reported. We therefore examined the association between coffee consumption and HF hospitalization or mortality in women.

METHODS AND RESULTS

We conducted a prospective, observational study of 34 551 participants of the Swedish Mammography Cohort who were 48 to 83 years old and did not have HF, diabetes, or myocardial infarction at baseline. Diet was measured using food-frequency questionnaires. Cox models were used to calculate hazard ratios of HF hospitalization or death from HF as the primary cause, as determined through the Swedish inpatient and cause-of-death registers between January 1, 1998, and December 31, 2006. Over 9 years of follow-up, 602 HF events occurred. Women who consumed ≥5 cups of coffee per day did not have higher rates of HF events than those who consumed <5 cups per day (multivariable-adjusted hazard ratio, 0.93; 95% confidence interval, 0.72 to 1.20). Compared with women who consumed ≤1 cup of coffee per day, hazard ratios were 1.01, 0.82, 0.94, and 0.87 for women who consumed 2, 3, 4, and ≥5 cups per day, respectively (P for trend=0.23). Further adjustment for self-reported hypertension did not change the results.

CONCLUSIONS

In this population of middle-aged and older women, we did not find an association between coffee consumption and incidence of HF events.

Methylxanthines and human health: epidemiological and experimental evidence

When considering methylxanthines and human health, it must be recognized that in many countries most caffeine is consumed as coffee. This is further confounded by the fact that coffee contains many bioactive substances in addition to caffeine; it is rich in phenols (quinides, chlorogenic acid, and lactones) and also has diterpenes (fatty acid esters), potassium, niacin, magnesium, and the vitamin B(3) precursor trigonelline. There is a paradox as consumption of either caffeine or caffeinated coffee results in a marked insulin resistance and yet habitual coffee consumption has repeatedly been reported to markedly reduce the risk for type 2 diabetes. There is strong evidence that caffeine reduces insulin sensitivity in skeletal muscle and this may be due to a combination of direct antagonism of A(1) receptors and indirectly β-adrenergic stimulation as a result of increased sympathetic activity. Caffeine may also induce reduced hepatic glucose output. With the exception of bone mineral, there is little evidence that caffeine impacts negatively on other health issues. Coffee does not increase the risk of cardiovascular diseases or cancers and there is some evidence suggesting a positive relationship for the former and for some cancers, particularly hepatic cancer.

Efficacy of dietary behavior modification for preserving cardiovascular health and longevity

Cardiovascular disease (CVD) and its predisposing risk factors are major lifestyle and behavioral determinants of longevity. Dietary lifestyle choices such as a heart healthy diet, regular exercise, a lean weight, moderate alcohol consumption, and smoking cessation have been shown to substantially reduce CVD and increase longevity. Recent research has shown that men and women who adhere to this lifestyle can substantially reduce their risk of coronary heart disease (CHD). The preventive benefits of maintaining a healthy lifestyle exceed those reported for using medication and procedures. Among the modifiable preventive measures, diet is of paramount importance, and recent data suggest some misconceptions and uncertainties that require reconsideration. These include commonly accepted recommendations about polyunsaturated fat intake, processed meat consumption, fish choices and preparation, transfatty acids, low carbohydrate diets, egg consumption, coffee, added sugar, soft drink beverages, glycemic load, chocolate, orange juice, nut consumption, vitamin D supplements, food portion size, and alcohol.