http://www.medscape.com/viewarticle/588403?src=mp&spon=17&uac=119129SZ
Coffee Intake Associated With Decreased Stroke Risk in Women
Susan Jeffrey
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February 18, 2009 - A new analysis of data from the Nurses' Health Study
shows that long-term consumption of up to 4 or more cups of coffee per day
was not associated with an increased risk for stroke and actually appeared
to be protective against stroke in women who did not also smoke.
Among women who currently smoked, there appeared to be no effect of coffee
intake, neither raising nor lowering stroke risk. No association was seen
with other caffeinated drinks, including tea or soft drinks, and
decaffeinated coffee still showed a trend toward a protective effect.
"Our data support the hypothesis that components in coffee other than
caffeine may lower the risk for stroke, although the association was modest
and the biological mechanism is unclear," the researchers, with first author
Ester Lopez-Garcia, PhD, from the Universidad Autonoma de Madrid, Spain, and
colleagues at the Harvard School of Public Health, in Boston, Massachusetts,
conclude.
Their report was published online February 16 and will appear in the March 3
print issue of Circulation.
Studies Inconclusive
Recently reported data have suggested that coffee does not increase the risk
for coronary heart disease and may be protective against type 2 diabetes,
the authors write. Data on the relationship of coffee intake and stroke are
"sparse," they note, and have been somewhat contradictory.
In this study, they analyzed data from the Nurses' Health Study, a
prospective cohort of 83,076 women who were free of stroke, coronary heart
disease, diabetes, or cancer at baseline. Coffee consumption was assessed
first in 1980 and then every 2 to 4 years thereafter, with follow-up over 24
years through 2004.
Over this period, 2280 strokes occurred among the women: 1224 ischemic
strokes, 426 hemorrhagic strokes, and 630 strokes of undetermined cause.
After adjustment for factors including age, smoking status, body-mass index,
physical activity, alcohol intake, menopausal status, hormone therapy,
aspirin use, and dietary factors, they found no increase in the risk for
stroke associated with increasing coffee intake, and evidence for a
protective effect for intakes of 2 or more cups per day vs less than 1 cup
per month (P for trend = .003)
Relative Risk of Stroke With Increasing Coffee Intake Coffee Intake (Cups)
Relative Risk 95% CI
< 1/month 1.0 (Referent) -
1/month - 4/week 0.98 0.84 - 1.15
5 - 7/week 0.88 0.77 - 1.02
2 - 3/day 0.81 0.70 - 0.95
> 4/day 0.80 0.64 - 0.98
After further adjustment for high blood pressure, hypercholesterolemia, and
type 2 diabetes, the inverse association remained significant, the authors
noted.
Because cigarette smoking is more common in coffee drinkers and a strong
confounder of stroke risk, they stratified the data by smoking status. They
found that the association was stronger among never or past smokers than
among current smokers, suggesting that "the potential benefit of coffee
consumption cannot counterbalance the detrimental effects smoking has on
health," the authors write.
Relative Risk of Stroke With Increasing Coffee Consumption by Smoking Status
Smoking Status Relative Risk (> 4 Cups/Day vs < 1 Cup/Month) 95% CI
Never or past smokers 0.57 0.39 - 0.84
Current smokers 0.97 0.63 - 1.48
Other drinks containing caffeine, including tea and caffeinated soft drinks,
were not associated with stroke, they note. Decaffeinated coffee was
associated with a trend toward lower stroke risk after adjustment for
consumption of caffeinated coffee (relative risk, 0.89 for 2 or more cups
per day vs less than 1 per month; 95% CI, 0.73 - 1.08; P for trend = .05).
More research will be required before implications for public health and
clinical practice are considered, the authors write. However, there does not
at least appear to be any risk for stroke associated with coffee intake for
those who already drink it.
In a news release from the American Heart Association, Dr. Lopez-Garcia
noted, "Anyone with health problems that can be worsened by coffee
(insomnia, anxiety, hypertension, or heart problems) should talk to their
doctor about their specific risk."
The study was funded by grants from the National Institutes of Health. The
authors have disclosed no relevant financial relationships.
Circulation. Published online February 16, 2009. Abstract
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Susan Jeffrey is News Editor for Medscape Neurology & Neurosurgery. She has
been writing principally for physician audiences for nearly 20 years. Most
recently, she was news editor of thekidney.org and also wrote for
theheart.org; both of these Web sites have been acquired by WebMD. Prior to
that, she spent 10 years covering neurology topics for a Canadian newspaper
for physicians. She can be contacted at [log in to unmask]
Medscape Medical News 2009. C 2009 Medscape
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