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Coffee Drinkers Have Lower Stroke Risk

Posted: Sunday, March 07, 2010

Drinking just one cup of coffee a day -- either regular or decaffeinated -- was associated with a 30% reduced risk of stroke, a large, prospective study showed.

Greater consumption did not heighten the apparent protective effect, according to Yangmei Li, MPhil, of the University of Cambridge in the U.K.

The results, gathered over a mean 12-year follow-up, were not affected by adjusting for several known stroke risk factors, Li reported at the American Stroke Association meeting.

Coffee drinking has been linked to lower risks of several other conditions, including Type 2 diabetes and impaired cognition.

Studies examining the association with stroke, however, have been mixed, with some showing no relationship and others echoing the lower risk in the current analysis.

Li and her colleagues explored the issue using data on 9,978 men and 12,254 women from the U.K. general population who were taking part in the European Prospective Investigation into Cancer (EPIC)-Norfolk. The participants' mean age was 59 (range 39 to 79). All were free of known heart disease, stroke, and cancer at the baseline period from 1993 to 1997. Overall, 17,807 reported drinking some amount of coffee -- 3.1 cups a day on average -- and 4,425 said they never drank any coffee.

Through March 2008, 855 strokes occurred, with a lower risk among those who reported drinking any amount of coffee.

Adjusting for smoking, social class, educational level, body mass index, alcohol intake, physical activity, tea drinking, urinary sodium:creatinine, urinary potassium:creatinine, plasma vitamin C, systolic blood pressure, diabetes, and serum cholesterol did not affect the results.

Although men appeared to derive more of a benefit from drinking coffee than women -- HR 0.62 versus 0.84 -- the confidence intervals overlapped, and it was not clear that they were actually different. Among current smokers, coffee drinkers had a 61% reduced risk of stroke (HR 0.59, 95% 0.38 to 0.94). Li noted that the subgroup analyses may have lacked statistical power.

Commenting on the study, Daniel Lackland, DrPH, of the Medical University of South Carolina in Charleston, said the main weakness of the study was the use of self-reported data, which makes it difficult to determine the actual quantity of coffee consumed. He said that even if the association is confirmed, it would be hard to identify the mechanism underlying it, which would be the next challenge.

Compounds in the coffee itself, something linked to the act of coffee drinking, or social behaviors surrounding coffee drinking could all be involved, he said.

Li could not identify a mechanism either, but suggested that compounds in coffee might benefit by improving insulin sensitivity, inhibiting platelet aggregation, and decreasing endothelial dysfunction. Coffee has also been shown to have some antioxidant properties.

Until a mechanism is established, probably in a large clinical trial, Lackland said, it is unlikely the medical community will be telling patients to drink more coffee to prevent stroke.

"Are you going to see this in the recommendations? I don't think right now," Lackland said.

Practice Pearls:

Explain to interested patients that this study could not establish a causal relationship between coffee drinking and stroke risk.

Source: Diabetes In Control: Li Y, et al "Coffee consumption and risk of stroke in men and women: the European Prospective Investigation into Cancer-Norfolk prospective population study" AHA 2010; Abstract LB P5.

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