Caffeine Unlikely to Make

Hearts Jittery
No link between chronic consumption of coffee, tea,
chocolate and ectopy
That extra morning espresso, chai tea, or plain old cup of joe may
give you a buzz, but it probably will not make your heart take extra
beats, according to findings from a study examining the impact of
food and drink consumption on cardiac ectopy.
Based on data gathered in community-dwelling participants in
the Cardiovascular Health Study, there was no evidence that
frequent consumption of caffeine-containing foods, including
coffee, tea, or chocolate, had any impact on premature atrial
contractions (PACs) and premature ventricular contractions
(PVCs), reported Shalini Dixit, BA, of the University of California
San Francisco, and colleagues.
After adjusting for potential confounders, more frequent
consumption of these foods was not associated with ectopy, they
wrote in the Journal of the American Heart Association.
"We found no evidence of a relationship between chronic caffeine
consumption and frequency of these extra beats," coauthor Gregory Marcus, MD, told MedPage Today. However,
he added that the group was not able to measure the effects of
acute caffeine exposure on heart rhythm, which was a study
limitation.

In an accompanying editorial, cardiologists from the Atlanta VA

Medical Center and Emory University reviewed the evidence
examining the impact of caffeine consumption on the heart.
"Recently published studies, including prospective cohorts, clinical
investigations, and meta-analyses, generally show coffee
consumption is safe for the heart," wrote Peter W.F. Wilson, MD,
and Heather Bloom, MD. "Concerning cardiovascular risk
factors, there is little evidence that chronic coffee intake
consumption raises blood pressure."
"Boiled coffee brewing may raise atherogenic lipid levels and
other brewing methods do not appear to have this effect. Finally,
there is little risk for atrial or ventricular arrhythmias at most of the
levels of caffeine consumption in our society," they added.
The study by Dixit's group included 1,388 people over the age of
64 (46% male, mean age 72) without persistent atrial fibrillation
(AF) who completed baseline food frequency assessments and
underwent 24-hour ambulatory electrocardiography (Holter)
monitoring.
A total of 840 (61%) participants reported consuming more than
one caffeinated product per day. Women were more likely than
men to consume at least one caffeine-containing product daily,
and alcohol drinkers also consumed more caffeine than
nondrinkers.
The authors reported that there were no differences in the number
of PACs or PVCs/hour across levels of coffee, tea, and chocolate
consumption. After adjustment for potential confounders, more
frequent consumption of these products was not associated with
ectopy.

Also, when combined dietary intake of coffee, tea, and chocolate

were examined as a continuous measure, no relationships were
observed after multivariable adjustment: 0.48% fewer PACs/hour
(95% CI 4.60 to 3.64) and 2.87% fewer PVCs/hour (95% CI 8.18
to 2.43) per one-serving/week increase in consumption.
While premature cardiac contractions are common and often
asymptomatic, there is increasing clinical evidence linking both
PACs and PVCs to increased cardiovascular risk, the authors
pointed out.
"Increased PACs, even among healthy individuals, have been
associated with incident AF, stroke and death. Furthermore, the
presence of PVCs in those free of heart disease has been
associated with an increased risk of incident heart failure, CAD
events and CAD-related deaths," they wrote.
They also noted that while caffeine consumption, especially coffee
drinking, has long been related to cardiac ectopy and arrhythmias
"by anecdote and biological plausibility," the evidence supporting
the link is minimal.
Other study limitations included the reliance on participant selfreport and the use of food frequency questionnaires, which
assessed habitual dietary patterns over extended periods of time,
rather than what the person consumed immediately before and
during the Holter monitoring.
"This is really an interesting paradox," Marcus said. "The general
belief is that caffeine is bad for your heart, but for most people this
doesn't seem to be true. For people without arrhythmias, the data
are pretty compelling that chronic consumption of caffeine does
not lead to extra beats."

He added that there is even a reason to believe that caffeine may

reduce the risk for atrial fibrillation.
"We found some evidence that caffeine may reduce some
arrhythmias in our cohort," he said.
Despite the lack of supporting evidence, Marcus noted that
clinicians and treatment guidelines often recommend either
limiting caffeine consumption or complete avoidance to patients
with premature cardiac contractions and arrhythmias.
"My clinical take is that the response to caffeine is somewhat
idiosyncratic," he said. "It may trigger this response in some
people, but not in others. So it is probably reasonable to allow
patients who want to drink coffee or tea or eat chocolate to
experiment to see how these products affect them."
Wilson and Bloom stated hat results from the current study are
"relevant to healthy older adults who are relatively asymptomatic
and who report modest amounts of caffeine intake."
They pointed out that the "epidemiology" of caffeine consumption
has changed over the last 20 years, with the growing popularity of
specialty coffee drinks and energy drinks.
A restaurant double espresso (2 ounces, 150 mg caffeine, 0
calories) habit may not be problematic, but what, they asked,
about a 20-oz peppermint mocha that clocks in at 415 mg caffeine
and 440 calories or a 16-oz energy drink with 160 mg caffeine and
300 calories?