Long-Term Coffee Consumption and Risk of Cardiovascular Disease: A Systematic Review and a Dose-Response Meta-Analysis of Prospective Cohort Studies

Abstract

Conclusions: Outcomes for repair of ruptured abdominal aortic aneurysms (rAAA) might be improved by wider use of local anesthesia for EVAR and by recognizing that a minimum blood pressure of 70 mmHg may be too low a threshold for permissive hypotension.Summary: Most data on outcomes of patients with rAAAs are singlecenter studies and as such may be too small to identify clinical factors that could improve overall patient outcomes. The IMPROVE study is a pragmatic multicenter randomized clinical trial in which eligible patients with a clinical diagnosis of rAAA were allocated to a strategy of endovascular repair of RAAAA (EVAR) or to open repair. IMPROVE showed no difference in 30-day mortality with a strategy incorporating EVAR for repair of a rAAAA compared to a strategy of open repair for ruptured abdominal aortic aneurysm (IMPROVE trial investigators, Brit Med J 2014;348:f7661). In this paper the IMPROVE investigators sought to analyze influences of time and manner of hospital presentation, fluid volume status, type of anesthesia, type of endovascular repair and time to aneurysm repair on 30-day mortality for rAAA. This was a prespecified plan of analyses to include only the patients who underwent aneurysm repair for a proven diagnosis of rAAA . Adjustments were made for potential confounding factors. In IMPROVE, 568 of 613 randomized patients had a symptomatic or rAAA and diagnostic accuracy was 91%. Patients randomized outside routine working hours had higher operative mortality (adjusted odds ratio, 1.47, 95% CI, 1.00-2.17). There was no difference in mortality rates between those patients admitted directly to a trial center versus those transferred to a trail center from a referring institution. Lowest systolic blood pressure was strongly and independently associated with 30-day mortality (51% among those with systolic blood pressures below 70 mmHg). In addition, patients who received EVAR under local anesthesia alone had reduced 30-day mortality compared to those who had EVAR under general anesthesia (adjusted odds ratio, 0.27; 95% CI, 0.10-0.70). In patients with confirmed rupture the time from randomization to the operating suite was not associated with 30-day mortality (P ¼ .415).Comment: The data indicate that blood pressure of 70 mmHg may be too low for optimal results in a patient with rAAA and permissive hypotensive levels should be above this. In addition, when EVAR is used to treat a rAAAA it may be best to do it, if possible, under local anesthesia. Finally, given the fact that results for repair of rAAA are no worse for a patient who is transferred than for those with a primary presentation to a specialist center, along with the fact that patients undergoing off-hours repair do more poorly suggests that a skilled multidisciplinary vascular team including specialists anesthesia services is likely to provide the best results for repair of a rAAA in any individual region. Outcomes for patients with rAAA therefore may be best served by a policy of regionalization of care for such patients to speci...

Coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone improves postprandial endothelial dysfunction in patients with borderline and stage 1 hypertension

“…A single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone restored postprandial endothelial dysfunction by decreasing in oxidative stress. Epidemiologic studies have shown that coffee drinking is associated with lower risk of cardiovascular disease [15,[17][18][19]. In the present study, single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone, but not single intake of coffee with a high content of chlorogenic acids and high content of hydroxyhydroquinone or placebo coffee, significantly improved postprandial endothelial dysfunction.…”

“…In addition, the association between coffee drinking and risk of cardiovascular disease remains inconclusive [15,[17][18][19][20][21][22][23]. The reason for the controversial results remains unclear.…”

“…Coffee contains an abundance of polyphenols, which is the major source of dietary antioxidants [13,14]. Drinking coffee is associated with lower risks of metabolic syndrome, diabetes, and coronary heart disease [15][16][17][18][19]. However, there have been conflicting results regarding the association between coffee drinking and risk of cardiovascular disease [19][20][21][22][23].…”

“…Drinking coffee is associated with lower risks of metabolic syndrome, diabetes, and coronary heart disease [15][16][17][18][19]. However, there have been conflicting results regarding the association between coffee drinking and risk of cardiovascular disease [19][20][21][22][23]. The effect of coffee on endothelial function is also controversial [24][25][26][27].…”

Indian spices and Caffeine treatment for Obesity and Cardiovascular disease

“…Consumption of Indian spices need to be carefully controlled to avoid induction of obesity by complete nulli ication of caffeine's co-ordination of the neuroendocrine system by dysregulation of the brain, adipose tissue and liver interaction. Caffeine and its metabolism is critical to cardiovascular disease [50][51][52] with Indian spice intake (mg/day) now important with relevance to interference with caffeine's therapeutic properties in man and various species. Delayed caffeine clearance leads to interference with caffeine's bene icial effect on adipogenesis with increased transport to the brain relevant to mitochondrial induced apoptosis and the induction of Type 3 diabetes [26][27][28].…”