Practice Update: Cardiology

CORONARY HEART DISEASE 28

Coffee Consumption Associated With Reduced Mortality Risk Annals of Internal Medicine

were also observed for digestive disease mortal- ity for men (HR, 0.41 [CI, 0.32 to 0.54]; P for trend < 0.001) and women (HR, 0.60 [CI, 0.46 to 0.78]; P for trend < 0.001). Among women, there was a statistically significant inverse association of cof- fee drinking with circulatory diseasemortality (HR, 0.78 [CI, 0.68 to 0.90]; P for trend < 0.001) and cer- ebrovascular disease mortality (HR, 0.70 [CI, 0.55 to 0.90]; P for trend = 0.002) and a positive asso- ciation with ovarian cancer mortality (HR, 1.31 [CI, 1.07 to 1.61]; P for trend = 0.015). In the EPIC Bio- markers subcohort, higher coffee consumption was associated with lower serum alkaline phos- phatase; alanine aminotransferase; aspartate aminotransferase; γ-glutamyltransferase; and, in women, C-reactive protein, lipoprotein(a), and gly- cated hemoglobin levels. LIMITATIONS Reverse causality may have biased the findings; however, results did not differ after exclusion of participants who died within 8 years of baseline. Coffee-drinking habits were assessed only once. CONCLUSION Coffee drinking was associated with reduced risk for death from various causes. This relationship did not vary by country. Coffee drinking and mortality in 10 european countries: a multinational cohort study. Ann Intern Med 2017 Jul 11;[EPub Ahead of Print], MJ Gunter, N Murphy, AJ Cross, et al. www.practiceupdate.com/c/55697

Take-home message • The authors of this prospective cohort study of 521,330 people from 10 European countries evaluated the association between coffee con- sumption and mortality risk over a mean follow-up of 16.4 years. People with the highest coffee consumption had a significantly lower rate of all- cause mortality and mortality from digestive disease than those who did not drink coffee. In addition, women with high levels of coffee consumption had a lower rate of circulatory disease mortality and cerebrovascular disease mortality and a higher rate of ovarian cancer mortality than women who did not drink coffee. • Coffee consumption appears to be associated with a reduction in mor- tality risk across numerous European countries.

Abstract BACKGROUND The relationship between coffee consumption and mortality in diverse European populations with variable coffee preparation methods is unclear. OBJECTIVE To examine whether coffee con- sumption is associated with all-cause and cause-specific mortality. PARTICIPANTS 521 330 persons enrolled in EPIC (European Prospective Investigation into Can- cer and Nutrition). MEASUREMENTS Hazard ratios (HRs) and 95% CIs estimated using multivariable Cox propor- tional hazards models. The association of coffee consumption with serum biomarkers of liver function, inflammation, and metabolic health was evaluated in the EPIC Biomarkers subco- hort (n = 14 800). RESULTS During a mean follow-up of 16.4 years, 41 693 deaths occurred. Comparedwith nonconsum- ers, participants in the highest quartile of coffee consumption had statistically significantly lower all-cause mortality (men: HR, 0.88 [95% CI, 0.82 to 0.95]; P for trend < 0.001; women: HR, 0.93 [CI, 0.87 to 0.98]; P for trend = 0.009). Inverse associations respiratory, stroke, diabetes, and kidney deaths were all reduced. EPIC found that men and women in the highest quartile of coffee consumption had 12% and 7% reductions in all-cause mortality. Coffee was associated with reduced digestive disease deaths in both men and women. Circulatory and cerebrovascular disease mortality was reduced in women, but ovar- ian cancer mortality was increased. Most clinicians think of coffee as a source of caffeine and as a potential cause of palpitations, but coffee contains other com- pounds with potentially beneficial health effects. Indeed, in MEC, both caffeinated and decaffeinated coffee consumption was associated with reductions in death. A subset of 14,800 EPIC participants had biomarkers measured, and coffee use was associated with lower liver enzyme, hsCRP, lipoprotein(a), and hemoglobin A1c levels. DESIGN Prospective cohort study. SETTING 10 European countries.

COMMENT By Paul D Thompson MD Could My Coffee Be a Good Addiction? W hat a relief! I cannot function in the morning without a cup of cof- fee, and two large observational trials, the Multiethnic Cohort (MEC) study and the European Prospective Investiga- tion into Cancer and Nutrition (EPIC) study, found that coffee consumption is associ- ated with reduced total mortality. 1,2

These are observational studies and so cannot prove causation, but the enormous sample sizes and control for confound- ers provides credibility to the results. For those patients in whom caffeinated cof- fee worsens palpitations, decaffeinated coffee may be just as beneficial. These results can be used to reassure patients that their coffee addiction may be more beneficial than harmful, and to even sug- gest that an increase from no to some coffee may be beneficial. References 1. Park SY, Freedman ND, Haiman CA, et al. Association of coffee consumption with total and cause-specific mortality among nonwhite populations [published online July 11, 2017]. Ann Intern Med doi:10.7326/M16 2472. 2. Gunter MJ, Murphy N, Cross AJ, et al. Coffee drinking and mortality in 10 European countries: a multinational cohort study [published online July 11, 2017]. Ann Intern Med doi:10.7326/M16-2945.

MEC enrolled 185,855 individuals of African American, nativeHawaiian, JapaneseAmer- ican, and Latino descent. Coffee intake was assessed at baseline, and mortality was determined after an average of 16.2 years. EPIC enrolled 521,330 individuals from 10 European countries and determined mor- tality after an average of 16.4 years. MEC found that, compared with no cof- fee, 1, 2 to 3, and 4 or more cups per day reduced the risk of death by 12%, 16%, and 18%, respectively. Heart, cancer,

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