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      Consumption of Caffeinated Products and Cardiac Ectopy

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          Abstract

          Background

          Premature cardiac contractions are associated with increased morbidity and mortality. Though experts associate premature atrial contractions ( PACs) and premature ventricular contractions ( PVCs) with caffeine, there are no data to support this relationship in the general population. As certain caffeinated products may have cardiovascular benefits, recommendations against them may be detrimental.

          Methods and Results

          We studied Cardiovascular Health Study participants with a baseline food frequency assessment, 24‐hour ambulatory electrocardiography (Holter) monitoring, and without persistent atrial fibrillation. Frequencies of habitual coffee, tea, and chocolate consumption were assessed using a picture‐sort food frequency survey. The main outcomes were PACs/h and PVCs/hour. Among 1388 participants (46% male, mean age 72 years), 840 (61%) consumed ≥1 caffeinated product per day. The median numbers of PACs and PVCs/h and interquartile ranges were 3 (1–12) and 1 (0–7), respectively. There were no differences in the number of PACs or PVCs/h across levels of coffee, tea, and chocolate consumption. After adjustment for potential confounders, more frequent consumption of these products was not associated with ectopy. In examining combined dietary intake of coffee, tea, and chocolate as a continuous measure, no relationships were observed after multivariable adjustment: 0.48% fewer PACs/h (95% CI −4.60 to 3.64) and 2.87% fewer PVCs/h (95% CI −8.18 to 2.43) per 1‐serving/week increase in consumption.

          Conclusions

          In the largest study to evaluate dietary patterns and quantify cardiac ectopy using 24‐hour Holter monitoring, we found no relationship between chronic consumption of caffeinated products and ectopy.

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          Most cited references32

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          The Cardiovascular Health Study: design and rationale.

          The Cardiovascular Health Study (CHS) is a population-based, longitudinal study of coronary heart disease and stroke in adults aged 65 years and older. The main objective of the study is to identify factors related to the onset and course of coronary heart disease and stroke. CHS is designed to determine the importance of conventional cardiovascular disease (CVD) risk factors in older adults, and to identify new risk factors in this age group, especially those that may be protective and modifiable. The study design called for enrollment of 1250 men and women in each of four communities: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Pittsburgh, Pennsylvania. Eligible participants were sampled from Medicare eligibility lists in each area. Extensive physical and laboratory evaluations were performed at baseline to identify the presence and severity of CVD risk factors such as hypertension, hypercholesterolemia and glucose intolerance; subclinical disease such as carotid artery atherosclerosis, left ventricular enlargement, and transient ischemia; and clinically overt CVD. These examinations in CHS permit evaluation of CVD risk factors in older adults, particularly in groups previously under-represented in epidemiologic studies, such as women and the very old. The first of two examination cycles began in June 1989. A second comprehensive examination will be repeated three years later. Periodic interim contacts are scheduled to ascertain and verify the incidence of CVD events, the frequency of recurrent events, and the sequellae of CVD.
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            Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons.

            Numerous studies indicate that flavanols may exert significant vascular protection because of their antioxidant properties and increased nitric oxide bioavailability. In turn, nitric oxide bioavailability deeply influences insulin-stimulated glucose uptake and vascular tone. Thus, flavanols may also exert positive metabolic and pressor effects. The objective was to compare the effects of either dark or white chocolate bars on blood pressure and glucose and insulin responses to an oral-glucose-tolerance test in healthy subjects. After a 7-d cocoa-free run-in phase, 15 healthy subjects were randomly assigned to receive for 15 d either 100 g dark chocolate bars, which contained approximately 500 mg polyphenols, or 90 g white chocolate bars, which presumably contained no polyphenols. Successively, subjects entered a further cocoa-free washout phase of 7 d and then were crossed over to the other condition. Oral-glucose-tolerance tests were performed at the end of each period to calculate the homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI); blood pressure was measured daily. HOMA-IR was significantly lower after dark than after white chocolate ingestion (0.94 +/- 0.42 compared with 1.72 +/- 0.62; P < 0.001), and QUICKI was significantly higher after dark than after white chocolate ingestion (0.398 +/- 0.039 compared with 0356 +/- 0.023; P = 0.001). Although within normal values, systolic blood pressure was lower after dark than after white chocolate ingestion (107.5 +/- 8.6 compared with 113.9 +/- 8.4 mm Hg; P < 0.05). Dark, but not white, chocolate decreases blood pressure and improves insulin sensitivity in healthy persons.
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              Ventricular Ectopy as a Predictor of Heart Failure and Death.

              Studies of patients presenting for catheter ablation suggest that premature ventricular contractions (PVCs) are a modifiable risk factor for congestive heart failure (CHF). The relationship among PVC frequency, incident CHF, and mortality in the general population remains unknown.
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                Author and article information

                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                26 January 2016
                January 2016
                : 5
                : 1 ( doiID: 10.1002/jah3.2016.5.issue-1 )
                : e002503
                Affiliations
                [ 1 ]University of California, San Francisco San Francisco CA
                [ 2 ]Washington University School of Medicine St. Louis MO
                [ 3 ] Knight Cardiovascular InstituteOregon Health & Science University Portland OR
                [ 4 ]University of Washington and Group Health Research Institute Seattle WA
                Author notes
                [*] [* ] Correspondence to: Gregory M. Marcus, MD, MAS, 505 Parnassus Ave, M‐1180B, Box 0124, San Francisco, CA 94143‐0124. E‐mail: marcusg@ 123456medicine.ucsf.edu
                Article
                JAH31296
                10.1161/JAHA.115.002503
                4859368
                26813889
                65aed6b2-2676-4a0e-9987-ad65a0968679
                © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 05 August 2015
                : 03 December 2015
                Page count
                Pages: 10
                Categories
                Original Research
                Original Research
                Arrhythmia and Electrophysiology
                Custom metadata
                2.0
                jah31296
                January 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.8.9 mode:remove_FC converted:04.05.2016

                Cardiovascular Medicine
                arrhythmia,diet,electrophysiology,epidemiology,arrhythmias,diet and nutrition,risk factors

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