Coffee consumption and coronary artery calcium in young and middle-aged asymptomatic adults
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Coronary artery disease
ORIGINAL ARTICLE
Coffee consumption and coronary artery calcium in
young and middle-aged asymptomatic adults
Yuni Choi,1 Yoosoo Chang,1,2,3 Seungho Ryu,1,2,3 Juhee Cho,1,4,5 Sanjay Rampal,5,6
Yiyi Zhang,5 Jiin Ahn,1 Joao A C Lima,7 Hocheol Shin,1,8 Eliseo Guallar5
▸ Additional material is ABSTRACT Coronary artery calcium (CAC) detected by
published online only. To view Objective To investigate the association between cardiac CT is a subclinical marker of coronary ath-
please visit the journal online
(http://dx.doi.org/10.1136/
regular coffee consumption and the prevalence of erosclerosis that predicts future coronary heart
heartjnl-2014-306663). coronary artery calcium (CAC) in a large sample of young disease (CHD)12 in a wide range of ages, including
and middle-aged asymptomatic men and women. asymptomatic young adults.13 CAC provides infor-
For numbered affiliations see
end of article. Methods This cross-sectional study included 25 138 mation on underlying pathologic changes in coron-
men and women (mean age 41.3 years) without clinically ary arteries and thus allows for a detailed
Correspondence to evident cardiovascular disease who underwent a health assessment of the early stages of CVD, which is dis-
Dr Yoosoo Chang, Department screening examination that included a validated food tinct from the occurrence of plaque rupture and
of Occupational and
Environmental Medicine, frequency questionnaire and a multidetector CT to thrombosis in clinical events.14 Only two studies
Kangbuk Samsung Hospital, determine CAC scores. We used robust Tobit regression have examined the relationship between coffee con-
108 Pyung dong, Jongro-Gu, analyses to estimate the CAC score ratios associated with sumption and CAC, with inconsistent results.15 16
Seoul, 110-746, Republic of different levels of coffee consumption compared with no We therefore examined the association between
Korea; yoosoo.chang@gmail.
coffee consumption and adjusted for potential coffee consumption and the presence of CAC in a
com
confounders. large sample of asymptomatic men and women
Received 15 August 2014 Results The prevalence of detectable CAC (CAC score attending a health screening examination.
Revised 8 January 2015 >0) was 13.4% (n=3364), including 11.3% prevalence
Accepted 15 January 2015 for CAC scores 1–100 (n=2832), and 2.1% prevalence
for CAC scores >100 (n=532). The mean ±SD METHODS
consumption of coffee was 1.8±1.5 cups/day. The Study population
multivariate-adjusted CAC score ratios (95% CIs) The Kangbuk Samsung Health Study is a cohort
comparing coffee drinkers ofCoronary artery disease
Figure 1 Flow diagram of the included study participants. CAC, coronary artery calcium.
Assessment of coffee consumption defined as systolic blood pressure (SBP) ≥140 mm Hg, diastolic
Usual dietary consumption was assessed using a 103-item self- blood pressure ≥90 mm Hg, a participant report of a previous
administered FFQ designed for use in Korea.18 The reproduci- diagnosis, or current antihypertensive medication use.
bility and validity of the nutrient information provided by this Blood specimens were sampled from the antecubital vein after
FFQ have been evaluated among 124 Korean subjects aged 40–- at least a 10 h fast. Measurements of serum biochemical para-
70 years. Participants were asked how often, on average, they meters, including serum concentrations of glucose, haemoglobin
consumed each type of food or beverage during the past year. A1c (HbA1c), total cholesterol, triglycerides, LDL-C, high
The FFQ had three predefined categories of portion size, density lipoprotein cholesterol (HDL-C), and serum high sensi-
ranging from small to large, and nine predefined categories of tivity C reactive protein (hsCRP) have been described in detail
frequency, ranging from never or seldom to ≥ three times per elsewhere.17 Diabetes mellitus was defined as fasting serum
day for foods, and from never or seldom to ≥ five times per day glucose ≥126 mg/dL, HbA1c ≥6.5%, self-report of a previous
for beverages. Participants were also asked to report the con- diagnosis, or use of blood glucose lowering agents.
sumption period (ie, 3, 6, 9, or 12 months) for seasonal con- Hypercholesterolaemia was defined as a serum total cholesterol
sumption of fruits. The FFQ asked about total coffee ≥240 mg/dL, self-report of a previous diagnosis, or current use
consumption without differentiating between caffeinated and of cholesterol lowering medication. The Laboratory Medicine
decaffeinated coffee. However, decaffeinated coffee is not yet Department at Kangbuk Samsung Hospital has been accredited
widely popular in Korea.19 A recipe, portion size, and nutrient by the Korean Society of Laboratory Medicine and participates
database was constructed with a food composition table from annually in inspections and surveys by the Korean Association
the Korean Nutrition Society.20 of Quality Assurance for Clinical Laboratories and the College
of American Pathologists Proficiency Testing programme.
Measurement of CAC
All CT scans were obtained with a Lightspeed VCT XTe 64 slice Statistical analysis
multidetector CT (MDCT) scanner (GE Healthcare, Tokyo, Habitual coffee consumption was categorised as none,Coronary artery disease minimally active, HEPA, and unknown), smoking status (never, because of the possibility that they could represent indivi- former, and current), BMI (body mass index, kg/m2), parental duals with unfavourable health conditions, and each category history of CHD (yes vs no), alcohol consumption (none,
Coronary artery disease
Table 2 Coronary artery calcium (CAC) score ratios* (95% CIs) by categories of coffee consumption
Daily coffee consumption
NoneCoronary artery disease
Although none of the potential mediating variables fully
explained the relationship between coffee and the presence
of CAC, several mechanisms have been suggested for the
association between moderate coffee and cardiovascular risk.
Chronic coffee consumption has been associated with
reduced risk of type 2 diabetes,8 9 a strong risk factor for
atherosclerosis. In addition, coffee drinking might improve
insulin sensitivity and β-cell function, presumably due to
the presence of antioxidant compounds in the coffee.3–5
Although acute coffee consumption might increase blood
pressure, this effect seems to disappear with chronic coffee
consumption and large prospective studies do not support
the hypothesis that high coffee consumption increases the
risk of hypertension.1 In our data, we observed an inverse
relationship between regular coffee consumption and SBP, but
adjusting for SBP and other CVD risk factors did not materi-
Figure 2 OR of detectable coronary artery calcium scores (CAC score ally change the association between coffee consumption and
>0) by coffee consumption. The curves represent the adjusted OR of the presence of CAC. Coffee also contains phenolic com-
detectable CAC scores ( >0 Agatston unit) and coffee consumption. pounds with high antioxidant activity that might prevent
The dose response association of coffee consumption was estimated by LDL-C oxidation,6 7 and coffee consumption was inversely
using a linear and a quadratic term for coffee consumption in the associated with markers of inflammation28 and endothelial
multivariable logistic regression. The model adjusted for age, sex, dysfunction.29 On the other hand, coffee, particularly unfil-
centre, and year of screening examination, education level (high school
tered coffee, has shown a cholesterol raising effect.10 11
graduate or less, community college or university graduate, graduate
school or higher, and unknown), physical activity level (inactive, Further research is needed to understand the potential effects
minimally active, health enhancing physically active, and unknown), of moderate coffee consumption on CVD risk, which are
smoking status (never, former, and current), body mass index (kg/m2), likely to be complex and at least partly independent of trad-
parental history of coronary heart disease (yes vs no), alcohol itional CVD risk factors.
consumption (none, 4 cups/day) consumption was previous study did not show substantial differences in the associ-
associated with a decreased prevalence of a CAC score >400 ation between caffeinated and decaffeinated coffee and CAC.16
compared with ≤3 drinks/day in women, but an increased risk Finally, our results were based on a sample of relatively healthy,
was observed in non-smoking men. In the Coronary Artery Risk young and middle-aged, educated Koreans, and might not be
Development in Young Adults (CARDIA) study (n=5115),16 caf- generalisable to other populations.
feinated and decaffeinated coffee consumption was not asso- Our study also has several strengths. The large sample size
ciated with coronary calcification or with progression over provides sufficient power to detect the association between
5 years of follow-up. In the Rotterdam and CARDIA coffee drinking and CAC scores while controlling for a wide
studies,15 16 measurements of coffee intake were taken several range of potential confounders. Data collection in the Kangbuk
years before CAC measurements (an average of 7 years in the Samsung Health Study is subject to careful standardisation and
Rotterdam Study and at least 8 years in CARDIA), which may quality control. Also, we had information on a large number of
have induced misclassification of exposure status. In our study, CVD risk factors that could be used to adjust for potential con-
coffee consumption was assessed on the same day of the screen- founders in multivariable models.
ing exam or in the previous 14 days, minimising misclassifica- In conclusion, we found that moderate daily coffee consump-
tion of exposure and avoiding biased reporting as dietary tion was associated with decreased prevalence of CAC in a large
information was collected before CAC measurements. The sample of asymptomatic adults free of CVD. Our study adds to
inconsistent findings across studies could also be attributable to a growing body of evidence suggesting that coffee consumption
other methodological issues, including differences in sample might be inversely associated with CVD risk. Further research is
size, control for potential confounding factors, measures of warranted to confirm our findings and establish the biological
coffee consumption, study population (age, ethnicity, and sex basis of coffee’s potential preventive effects on coronary artery
composition), or prevalence of CAC. disease.
Choi Y, et al. Heart 2015;0:1–6. doi:10.1136/heartjnl-2014-306663 5Coronary artery disease
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Key messages 5 Bruce CR, Carey AL, Hawley JA, et al. Intramuscular heat shock protein 72 and
heme oxygenase-1 mRNA are reduced in patients with type 2 diabetes: evidence
that insulin resistance is associated with a disturbed antioxidant defense
What is already known on this subject?
mechanism. Diabetes 2003;52:2338–45.
The relationship between coffee consumption and 6 Gomez-Ruiz JA, Leake DS, Ames JM. In vitro antioxidant activity of coffee
cardiovascular disease is controversial. Several large prospective compounds and their metabolites. J Agric Food Chem 2007;55:6962–9.
studies and reviews have concluded that habitual coffee 7 Natella F, Nardini M, Belelli F, et al. Coffee drinking induces incorporation of
consumption may be associated with decreased risk of phenolic acids into LDL and increases the resistance of LDL to ex vivo oxidation in
humans. Am J Clin Nutr 2007;86:604–9.
cardiovascular events, and this association was most evident for 8 Huxley R, Lee CM, Barzi F, et al. Coffee, decaffeinated coffee, and tea consumption
moderate coffee consumption levels. in relation to incident type 2 diabetes mellitus: a systematic review with
meta-analysis. Arch Intern Med 2009;169:2053–63.
What might this study add? 9 Freedman ND, Park Y, Abnet CC, et al. Association of coffee drinking with total
In this large sample of Korean men and women free of clinically and cause-specific mortality. N Engl J Med 2012;366:1891–904.
evident cardiovascular disease, coffee consumption was 10 Ranheim T, Halvorsen B. Coffee consumption and human health--beneficial or
associated with a lower prevalence of coronary artery calcium, a detrimental?--mechanisms for effects of coffee consumption on different risk factors
for cardiovascular disease and type 2 diabetes mellitus. Mol Nutr Food Res
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was U-shaped, with participants drinking 3–You can also read
