For Class

Heart beat
Research continues to serve up heart perks for coffee drinkers
Coffee's reputation for being okay for cardiovascular health, evidence for this recommendation. Of 11 studies in hu-
or more than okay, continues to grow. Here's a roundup mans, one showed a link between caffeine and prema-
of study results from the first half of 2011. All of the refer- ture contractions of the ventricles, two showed problems
ences are listed at www.health.harvard.edu/heartextra.
associated with drinking a lot of coffee (more than nine
Heart failure. Women who drink coffee are slightly cups a day), and the remaining eight showed no effect of
less likely to develop heart failure than women who don't drinking caffeinated beverages or avoiding caffeine. Al-
drink coffee. Coffee drinking had little effect on heart fail- though the researchers acknowledge that some people
ure in men.
are more susceptible to the effects of caffeine than others,
Stroke. Women who drink coffee are about 25% less they suggest that caffeine in moderation may be fine for
likely to have a stroke than those who don't. (The study many people with a known or suspected heart rhythm
didn't include men.)
problem.
Blood clots in the legs or lungs. Men and women who
Beyond the heart. Drinking a few cups of coffee a
drink coffee may be less likely to develop a blood clot in day was linked to lower rates of estrogen-negative breast
the legs (deep-vein thrombosis) or the lungs (pulmonary cancer, type 2 diabetes, and aggressive prostate cancer.
embolism) than nondrinkers.
Keep in mind that all of these studies looked at what
Premature death. In a 24-year study of female nurses, people choose to do. It's possible that folks who enjoy the
coffee drinkers--including those who downed four or bitter brew are different from folks who don't drink coffee,
more cups a day--were no more likely to have died than and these differences account for the benefits. The con-
women who didn't drink coffee.
vergence of evidence, though, suggests that coffee real y
Heart rhythm problems. Doctors often advise their is okay. But it doesn't suggest that you need to start drink-
patients with heart palpitations or other rhythm prob- ing coffee, especial y if you don't like its taste or smel .
lems to stop drinking coffee and other caffeinated bever- And adding cream, sugar, and flavorings to make it go
ages. Northwestern University researchers reviewed the down would completely defeat the purpose.
"Just in case" artery scans offer
No connection between ARBs and cancer
little or no payoff, possible harm
In 2010, a controversial analysis sug-
The carotid arteries that run up either side of the neck are
gested that angiotensin-receptor blockers
prone to becoming narrowed by cholesterol-filled plaque. A
(ARBs) increased the risk of developing
test called carotid ultrasound can identify a narrowing, also
cancer, especial y lung cancer (see the December 2010 Heart
called a stenosis, quickly, safely, and without any immediate
Letter). Not so, says an FDA safety alert issued in June 2011.
potential for harm. This test makes perfect sense for someone
ARBs are widely used to treat high blood pressure. They
experiencing lightheadedness, memory loss, or the warning
include azilsartan medoxomil (Edarbi), candesartan (Ata-
signs of a stroke or mini-stroke.
cand), eprosartan (Teveten), irbesartan (Avapro), losar-
In people who have their carotid arteries checked "just
tan (Cozaar, generic), olmesartan (Benicar), telmisartan
in case," ultrasound doesn't do much good. University of
(Micardis), and valsartan (Diovan). Several combination
Wisconsin researchers tracked almost 600 people who
drugs include an ARB plus a diuretic or a calcium-channel
underwent carotid ultrasound for this reason. A year later,
blocker.
those whose scans had shown a significant narrowing were
The FDA analyzed data from 31 ARB trials with a total of
no more likely to have their blood pressure or cholesterol
156,000 participants. It found "no evidence of an increased
under control--two key steps for managing carotid stenosis--
risk of incident (new) cancer, cancer-related death, breast
than those whose arteries were clear, or to have made
cancer, lung cancer, or prostate cancer in patients receiving
healthy changes in diet, exercise, and other long-term health
ARBs." The cancer rate was 1.84 per 100 participants per
behaviors (Archives of Internal Medicine, March 28, 2011).
year among those taking a placebo and 1.82 per 100 partici-
Tests like these in seemingly healthy individuals often
pants per year among those taking an ARB.
cause more problems than they prevent. They can quickly
If you take an ARB for high blood pressure but hadn't
transform people into worried folks who need more tests,
first tried to control it with an ACE inhibitor, consider talk-
and maybe even procedures. And these procedures can't
ing with your doctor about trying one. ACE inhibitors work
make them feel better, because they started out feeling fine.
as well as ARBs, and many of them are generic (and thus
less expensive).
6 | Harvard Heart Letter | August 2011 www.health.harvard.edu

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