Prague -- The effect of coffee consumption on the risk of heart disease has stirred much debate in recent years. Earlier this year, for example, a 13-year follow-up study of 130,000 Americans reported that moderate coffee drinking actually reduces the risk of being hospitalised for heart rhythm problems - a somewhat surprising finding when so many people have "palpitations" after drinking strong coffee and are advised a decaffeinated variety. And while some individual studies have found that coffee may increase levels of cholesterol or even blood pressure, the overall view is that everyday coffee consumption does not in itself increase the risk of coronary heart disease.(1)
Most of the studies behind these claims, however, are considering the effect of coffee in the primary prevention (or risk) of heart disease; less well explored is the association between coffee and recurring disease in those who have already experienced an acute coronary event such as a heart attack.
Now, a report presented in Prague at EuroPRevent 2010, the year's principal event for all those engaged in the prevention of cardiovascular diseases, suggests that moderate coffee consumption after an acute coronary event substantially decreases the likelihood of developing left ventricular systolic dysfunction (LVSD), a condition in which the heart's ability to pump blood is reduced by at least 40% and which is a common precursor of heart failure. However, this beneficial effect was only apparent if the patient's blood pressure was in the normal range. The extent of any LVSD is usually measured as a percentage "ejection fraction". The findings emerged from a study of 374 patients who had all had an acute coronary event - 144 male and 50 female patients who developed LVSD with an ejection fraction of 40% or less, and 129 male and 51 female patients without LVSD (an ejection fraction of 50% or more). The investigators, from Harokopio University and the Hippokration Hospital in Athens, Greece, recorded detailed information about lifestyle characteristics (physical activity, smoking) and nutritional habits, including coffee consumption. The study that was performed under the supervision of Professor Christodoulos Stefanadis and Dr Christina Chrysohoou. Results showed that in those patients without raised blood pressure moderate coffee consumption of one or two cups a day was associated with an 88% lower likelihood of developing LVSD, and consumption of more than three cups with 90% lower than in those who did not drink coffee. However, this protective effect was not seen in those patients who also had high blood pressure, where the consumption of three or more cups a day was associated with 4.5-fold higher likelihood of developing LVSD. The investigators note that the effect of coffee on the risk of developing LVSD following an acute coronary event thus depends on blood pressure levels - and may therefore be associated with different outcomes. Commenting on the results, investigator Christina-Maria Kastorini said: "Coffee contains several biologically active compounds, which may have either beneficial or harmful effects on the cardiovascular system. Coffee is a rich dietary source of chlorogenic acid and antioxidant compounds, and may exert a protective effect against the development of LVSD in normotensive patients. However, in hypertensive patients coffee has a negative influence on blood pressure levels and the beneficial effect of these compounds may not be strong enough."
1.See, for example, Lopez-Garcia E, van Dam RM, Willett WC, et al. Coffee consumption and coronary heart disease in men and women: a prospective cohort study. Circulation 2006; 113: 2045-2053. 2.Kastorini CM, Chrysohoou C, Panagiotakos DB et al. Moderate coffee consumption lowers the likelihood of developing left ventricular systolic dysfunction in post-acute coronary syndrome normotensive patients. Presented at EUROPREVENT 2010, Prague 5th-7th May.
* Left ventricular systolic dysfunction is a condition in which the left ventricle can manage to eject with each contraction no more than 40% (occasionally 35%) of the blood within it. LVSD is usually detected by echocardiogram and usually before the patient has symptomatic heart failure. Heart failure is by far the single biggest reason for acute hospital admission. Around 30 million people in Europe have heart failure and its incidence is still increasing: more cases are being identified, more people are living to an old age, and more are surviving a heart attack but with damage to the heart muscle.
* EuroPRevent is the annual meeting of the European Association for Cardiovascular Prevention and Rehabilitation, a registered branch of the European Society of Cardiology.
* The European Society of Cardiology (ESC) represents more than 62,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
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