Coffee consumption and coronary artery calcium in young and middle-aged asymptomatic adults

RESUMEN:

Objective To investigate the association between regular coffee consumption and the prevalence of coronary artery calcium (CAC) in a large sample of young and middle-aged asymptomatic men and women.

Methods This cross-sectional study included 25 138 men and women (mean age 41.3 years) without clinically evident cardiovascular disease who underwent a health screening examination that included a validated food frequency questionnaire and a multidetector CT to determine CAC scores. We used robust Tobit regression analyses to estimate the CAC score ratios associated with different levels of coffee consumption compared with no coffee consumption and adjusted for potential confounders.

Results The prevalence of detectable CAC (CAC score mayor a 0) was 13.4% (n=3364), including 11.3% prevalence for CAC scores 1–100 (n=2832), and 2.1% prevalence for CAC scores mayor to 100 (n=532). The mean ±SD consumption of coffee was 1.8±1.5 cups/day. The multivariate-adjusted CAC score ratios (95% CIs) comparing coffee drinkers of menor to 1, 1– menor que 3, 3– menor que5, and mayor o igual que 5 cups/day to non-coffee drinkers were 0.77 (0.49 to 1.19), 0.66 (0.43 to 1.02), 0.59 (0.38 to 0.93), and 0.81 (0.46 to 1.43), respectively (p for quadratic trend=0.02). The association was similar in subgroups defined by age, sex, smoking status, alcohol consumption, status of obesity, diabetes, hypertension, and hypercholesterolaemia.

Conclusions In this large sample of men and women apparently free of clinically evident cardiovascular disease, moderate coffee consumption was associated with a lower prevalence of subclinical coronary atherosclerosis.

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TOMADO DE :heart.bmj.com/

Heart Attacks in Young Women -- Not All Have Chest Pain

hest pain is recognized as a symptom of heart troubles, but one out of five women aged 55 years or less having a heart attack do not experience this symptom, according to a study led by the Research Institute of the McGill University Health Centre (RI-MUHC). The research findings, gathered from partner institutions across Canada including the University of British Columbia (UBC), are the first to describe this phenomenon in young women. The study, published in JAMA Internal Medicine, has implications for emergency room healthcare professionals and for at-risk individuals, as seconds matter when it comes to the accurate diagnosis and treatment of heart attack.

We need to move away from the image of an older man clutching his chest, when we think about acute coronary syndrome (ACS -- the umbrella term referring to heart attacks and angina), says senior author of the study, Dr. Louise Pilote, director of the Division of General Internal Medicine at the MUHC and McGill University and professor of medicine at McGill University. "The reality is that chest pain, age and gender are no longer the definers of a heart attack. Our study demonstrates that young people and women who come into the emergency without chest pain, but other telltale ACS symptoms such as weakness, shortness of breath and/or rapid heartbeats are in crisis. We need to be able to recognize this and adapt to new standard assessments in previously unrecognized groups such as young women."

"Women less than 55 years old are more likely to have their ACS misdiagnosed in the ER than men, and they have higher risk of death," adds first author Dr. Nadia Khan, associate professor of Medicine, UBC. "The public and physicians need to be aware of this problem."

Pain not an indicator of disease severity

Drs. Pilote, Khan and colleagues evaluated more than 1000 young patients who were hospitalized for ACS. Their findings showed that women were less likely to experience chest pain compared with men and that the absence of this pain did not correlate with less severe heart attacks. Patients without chest pain had fewer symptoms overall but their ACS was not less severe. The diagnosis of ACS therefore depended on detailed cardiological assessments.

"It is important to remember that chest pain is a main indicator of ACS, but not the only one," says Dr. Pilote.

"We need to remind ourselves that even without chest pain, something serious could still be happening," adds Dr. Khan

McGill University Health Centre. "Heart attacks in young women -- not all have chest pain."ScienceDaily, 16 Sep. 2013. Web. 18 Sep. 2013

Lower coronary flow during hypoglycemia ups CV risk for type 1 diabetes

Decreased coronary flow reserve during periods of hypoglycemia may raise the risk for myocardial ischemia in patients with type 1 diabetes, a researcher said here.

“Low blood sugar provokes profound hemodynamic effects through sympathoadrenal stimulation. It is associated with an increase in heart rate and myocardial contraction and, thereby, cardiac output. Also it decreases central blood pressure and increases arterial elasticity in normal individuals, causing the heart to generate a pulse wave that bounces off the central arteries during diastole, thereby aiding coronary filling. However, in patients with type 1 diabetes, especially of longer duration, arterial stiffness causes the pulse wave to return during systole and there is suboptimal filling of the coronary flow,” Radzi M. Noh, MRCP, of the Royal Infirmary of Edinburgh, said during a presentation. “In addition to increasing myocardial workload, it increases the risk for myocardial ischemia.”

To evaluate whether periods of hypoglycemia worsened this risk, Noh and colleagues examined participants during periods of experimental hypoglycemia. They included 16 participants with type 1 diabetes of varying duration and 10 healthy, age-matched controls. These participants were aged 18 to 46 years (median, 29 years); had HbA1c ranging from 7% to 9% (median, 8.3%), no microvascular complications and were being treated with insulin only.

The researchers used a hyperinsulinemic glucose clamp to induce hypoglycemia and measured coronary flow reserve during euglycemia, defined as 4.5 mmol/L, and hypoglycemia, defined as 2.5 mmol/L. They employed transthoracic echocardiography to assess coronary blood flow velocity in the left anterior descending coronary artery before and during adenosine-induced microvascular hyperemia. Coronary flow reserve is measured as the maximum hyperemic blood flow velocity divided by baseline blood flow velocity.

Data indicated a trend toward lower coronary flow reserve in patients with diabetes vs. the control arm (3.69 vs. 4; P=.07). Further, at 3.56, patients with a longer duration of diabetes had the lowest coronary flow reserve when compared with both patients with and without diabetes. In contrast, coronary flow reserve rose slightly in the control group vs. the diabetes group (4.08 vs. 3.53; P<.05).

“During acute hypoglycemia, a modest reduction of coronary flow reserve may be well tolerated in healthy individuals, but may promote ischemia in older people with diabetes who have coronary heart disease,” Noh concluded. –

Referencia: Noh RM. Abstract #171-OR. Presented at: the American Diabetes Association’s 72nd Scientific Sessions; June 8-12; Philadelphia.

Tomado de: Endocrine today.com