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      Coffee Consumption and Risk of Atrial Fibrillation in the Physicians’ Health Study

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          Abstract

          Background

          Although coffee consumption is often reported as a trigger for atrial fibrillation ( AF) among patients with paroxysmal AF, prospective studies on the relation of coffee consumption with AF risk have been inconsistent. Hence, we sought to assess the association between coffee consumption and risk of AF in men.

          Methods and Results

          We prospectively studied men who participated in the Physicians’ Health Study (N=18 960). Coffee consumption was assessed through self‐reported food frequency questionnaires. The incidence of AF was assessed through annual questionnaires and validated through review of medical records in a subsample. Cox proportional hazard models were used to calculate hazard ratios and 95% CIs of AF. The average age was 66.1 years. A total of 2098 new cases of AF occurred during a mean follow‐up of 9 years. Hazard ratios (95% CI) of AF were 1.0 (reference), 0.85 (0.71‐1.02), 1.07 (0.88‐1.30), 0.93 (0.74‐1.17), 0.85 (0.74‐0.98), 0.86 (0.76‐0.97), and 0.96 (0.80‐1.14) for coffee consumption of rarely/never, ≤1 cup/week, 2 to 4 cups/week, 5 to 6 cups/week, 1 cup/day, 2 to 3 cups/day, and 4+ cups/day, respectively; adjusting for age, smoking, alcohol intake, and exercise ( P for nonlinear trend=0.01). In a secondary analysis the multivariable adjusted hazard ratio (95% CI) of AF per standard deviation (149‐mg) change in caffeine intake was 0.97 (0.92‐1.02).

          Conclusions

          Our data suggest a lower risk of AF among men who reported coffee consumption of 1 to 3 cups/day.

          Abstract

          See Editorial Aleong and Sandhu

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          Most cited references20

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          Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study.

          To determine the independent risk factors for atrial fibrillation. Cohort study. The Framingham Heart Study. A total of 2090 men and 2641 women members of the original cohort, free of a history of atrial fibrillation, between the ages of 55 and 94 years. Sex-specific multiple logistic regression models to identify independent risk factors for atrial fibrillation, including age, smoking, diabetes, electrocardiographic left ventricular hypertrophy, hypertension, myocardial infarction, congestive heart failure, and valve disease. During up to 38 years of follow-up, 264 men and 298 women developed atrial fibrillation. After adjusting for age and other risk factors for atrial fibrillation, men had a 1.5 times greater risk of developing atrial fibrillation than women. In the full multivariable model, the odds ratio (OR) of atrial fibrillation for each decade of advancing age was 2.1 for men and 2.2 for women (P < .0001). In addition, after multivariable adjustment, diabetes (OR, 1.4 for men and 1.6 for women), hypertension (OR, 1.5 for men and 1.4 for women), congestive heart failure (OR, 4.5 for men and 5.9 for women), and valve disease (OR, 1.8 for men and 3.4 for women) were significantly associated with risk for atrial fibrillation in both sexes. Myocardial infarction (OR, 1.4) was significantly associated with the development of atrial fibrillation in men. Women were significantly more likely than men to have valvular heart disease as a risk factor for atrial fibrillation. The multivariable models were largely unchanged after eliminating subjects with valvular heart disease. In addition to intrinsic cardiac causes such as valve disease and congestive heart failure, risk factors for cardiovascular disease also predispose to atrial fibrillation. Modification of risk factors for cardiovascular disease may have the added benefit of diminishing the incidence of atrial fibrillation.
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            Final report on the aspirin component of the ongoing Physicians' Health Study. Steering Committee of the Physicians' Health Study Research Group.

            The Physicians' Health Study is a randomized, double-blind, placebo-controlled trial designed to determine whether low-dose aspirin (325 mg every other day) decreases cardiovascular mortality and whether beta carotene reduces the incidence of cancer. The aspirin component was terminated earlier than scheduled, and the preliminary findings were published. We now present detailed analyses of the cardiovascular component for 22,071 participants, at an average follow-up time of 60.2 months. There was a 44 percent reduction in the risk of myocardial infarction (relative risk, 0.56; 95 percent confidence interval, 0.45 to 0.70; P less than 0.00001) in the aspirin group (254.8 per 100,000 per year as compared with 439.7 in the placebo group). A slightly increased risk of stroke among those taking aspirin was not statistically significant; this trend was observed primarily in the subgroup with hemorrhagic stroke (relative risk, 2.14; 95 percent confidence interval, 0.96 to 4.77; P = 0.06). No reduction in mortality from all cardiovascular causes was associated with aspirin (relative risk, 0.96; 95 percent confidence interval, 0.60 to 1.54). Further analyses showed that the reduction in the risk of myocardial infarction was apparent only among those who were 50 years of age and older. The benefit was present at all levels of cholesterol, but appeared greatest at low levels. The relative risk of ulcer in the aspirin group was 1.22 (169 in the aspirin group as compared with 138 in the placebo group; 95 percent confidence interval, 0.98 to 1.53; P = 0.08), and the relative risk of requiring a blood transfusion was 1.71. This trial of aspirin for the primary prevention of cardiovascular disease demonstrates a conclusive reduction in the risk of myocardial infarction, but the evidence concerning stroke and total cardiovascular deaths remains inconclusive because of the inadequate numbers of physicians with these end points.
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              All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995–2008: a Swedish nationwide long-term case–control study

              Aims To evaluate long-term all-cause risk of mortality in women and men hospitalized for the first time with atrial fibrillation (AF) compared with matched controls. Methods and results A total of 272 186 patients (44% women) ≤85 years at the time of hospitalization with incidental AF 1995–2008 and 544 344 matched controls free of in-hospital diagnosis of AF were identified. Patients were followed via record linkage of the Swedish National Patient Registry and the Cause of Death Registry. Using Cox regression models, the long-term relative all-cause mortality risk, adjusted for concomitant diseases, in women vs. controls was 2.15, 1.72, and 1.44 (P < 0.001) in the age categories ≤65, 65–74, and 75–85 years, respectively. The corresponding figures for men were 1.76, 1.36, and 1.24 (P < 0.001). Among concomitant diseases, neoplasm, chronic renal failure, and chronic obstructive pulmonary disease contributed most to the increased all-cause mortality vs. controls. In patients with AF as the primary diagnosis, the relative risk of mortality was 1.63, 1.46, and 1.28 (P < 0.001) in women and 1.45, 1.17, and 1.10 (P < 0.001) in men. Conclusion Atrial fibrillation was an independent risk factor of all-cause mortality in patients with incident AF. The concomitant diseases that contributed most were found outside the thromboembolic risk scores. The highest relative risk of mortality was seen in women and in the youngest patients compared with controls, and the differences between genders in each age category were statistically significant.
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                Author and article information

                Contributors
                vbodar@bwh.harvard.edu
                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
                05 August 2019
                06 August 2019
                : 8
                : 15 ( doiID: 10.1002/jah3.2019.8.issue-15 )
                : e011346
                Affiliations
                [ 1 ] Veterans Affairs Healthcare System Boston MA
                [ 2 ] Division of Aging Department of Preventive Medicine Brigham and Women's Hospital, Harvard Medical School Boston MA
                [ 3 ] Division of Preventive Medicine Center for Arrhythmia Prevention Brigham and Women's Hospital, Harvard Medical School Boston MA
                [ 4 ] Center for Arrhythmia Prevention Division of Preventive Medicine and Cardiovascular Disease Brigham and Women's Hospital, Harvard Medical School Boston MA
                Author notes
                [*] [* ] Correspondence to: Vijaykumar Bodar, MD, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Boston, MA 02120. E‐mail: vbodar@ 123456bwh.harvard.edu
                Article
                JAH34122
                10.1161/JAHA.118.011346
                6761675
                31378120
                96219a77-23b4-42dd-a20e-d0ed7f03dd21
                © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 30 October 2018
                : 02 April 2019
                Page count
                Figures: 1, Tables: 2, Pages: 6, Words: 4303
                Funding
                Funded by: National Heart, Lung, and Blood Institute
                Award ID: R21HL088081
                Funded by: National Institutes of Health
                Award ID: CA‐34944
                Award ID: CA‐40360
                Award ID: CA‐097193
                Award ID: HL‐26490
                Award ID: HL‐34595
                Categories
                Original Research
                Original Research
                Preventive Cardiology
                Custom metadata
                2.0
                jah34122
                06 August 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.7 mode:remove_FC converted:06.08.2019

                Cardiovascular Medicine
                atrial fibrillation,caffeine,cardiovascular disease,coffee,epidemiology and nutrition,diet and nutrition,epidemiology,lifestyle,primary prevention

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