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I've recently had multiple heart attacks (3 in about 14 months and the last in November) and am quite keen to avoid more in future and to try and keep going for some years yet (I'm 53).
My diet's not too bad (although hardly exemplary) and I'm trying to increase my activity levels (I haven't been able to cycle probably for well over a year).
Since I'm on a high dose of nitrates (Isotard) which dilate blood vessels to help prevent angina (which I still get despite 5 stents & some drug eluding balloons) I've limited myself to a single cup of caffeinated coffee a day as I believe caffeine can constrict blood vessels (I also suffer from Reynaud's Syndrome which results in blood restriction in the fingers); it seemed a good idea at the time.
However, I've just stumbled across a site on the internet suggesting that research shows that caffeinated coffee can actually help prevent heart disease and improve heart health.
Now I know that it probably isn't wise to rely on random internet sites for health information but I was wondering whether any of the doctors/medics on the forum might have a view on moderate caffeine intake and heart health (bearing in my ongoing treatment for angina & problems with Renaud's Syndrome).
I’ve limited myself to a single cup of caffeinated coffee a day
You know what - one good cup of coffee a day is plenty. Just make it a good one and take the time to enjoy it.
that caffeinated coffee can actually help prevent heart disease
you’re already doing that. Medicine is medicine only at the right time, the right place in the right dose. Otherwise it’s poison. More medicine isn’t better medicine
You need to speak to a doctor obvs but this is the study referred to I imagine, seems to be legit
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.113.005925
NHS reckon it doesn't make much difference
https://www.nhs.uk/news/food-and-diet/coffee-can-make-you-live-longer-claims/
you’re already doing that. Medicine is medicine only at the right time, the right place in the right dose. Otherwise it’s poison. More medicine isn’t better medicine
Think the study was talking about 3-5 cups per day
Who knows, I guess that the research shows a statistical possibility rather than identifying a definitive process.
I'm keen improve my heart health & reduce the chance of further heart attacks, but it seems counter-intuitive to take something known to constrict blood vessels when I'm heavily medicated to achieve the opposite (for angina). I've not been told to cut out coffee by consultants or cardiac nurses but it is suggested that you do if you have high blood pressure (which I don't).
you’re already doing that. Medicine is medicine only at the right time, the right place in the right dose. Otherwise it’s poison. More medicine isn’t better medicine
I'm not treating it as medicine (and I'm certainly not looking to pop high dosage caffeine pills). I'd only be looking at putting back 3 or 4 cups of coffee that I was drinking as part of a reasonably decent diet prior to my heart attacks.
Stable angina symptoms (in someone like yourself with known CAD) are not related to risk of MI. Once you separate out those things in your head, it gets easier to work out what to do.
Aspirin, statins and other anti platelet drugs (if prescribed) reduce your risk of future events (MI, death etc). ACE-inhibitors and beta blockers (and potentially some others) reduce the risk of heart failure in susceptible individuals +/- control BP. I.e. those are the things that may just make you live longer.
The other stuff (all those anti-anginals) are just there for symptoms. Similarly, if you drink more coffee and get worse angina, then stop. If you don’t notice any difference then you’re probably fine. Obviously moderation is important - eg you probably don’t want to run an elevated heart rate because of too much caffeine, for example.
Unless there is randomised data showing differences in outcomes, in most cases you can ignore concerns based on possible mechanisms of action (eg caffeine—> vasoconstriction) because there are hundreds of physiological pathways involved in pretty much anything you ingest. Trials comparing groups are better, but also note that ‘people who choose to drink coffee’ are not made the same as ‘people who choose not to drink coffee’ (economically, genetically, socially etc) so any trial that isn’t randomised is flawed.
TLDR; If something helps your symptoms, crack on, if it makes you worse then stop. And don’t try to guess mechanisms because a) you’re not a physiology scientist and b) it’s impossible anyway.
I’m a (cardiology) doctor, but crucially I’m not your doctor. Discuss any changes with them.
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Thanks Superficial, that's great. Thank you for taking the time to reply.
I think you can say one thing for definite - you can prove pretty much any theory if you look hard enough. Especially with the wealth of information available on the web, written and published by anyone from highly respected professors all the way to batsh8t crazy conspiracy theorists.
Caffeine is metabolised by an enzyme called CYP1A2. Some other drugs can block that enzyme, and that slows the elimination of consumed caffeine (ciprofloxacin, enoxacin, and fluvoxamine are the bad boys here). Check the drugs you are taking with your doctor. But one 80 mg dose of caffeine (double espresso) is unlikely to give you issues. you would most likely have noticed a more profound duration of effect for the world's most widely taken psychotropic drug by now if it were.
Your nitrate is not metabolized by the same pathway as caffeine.
And don’t try to guess mechanisms because a) you’re not a physiology scientist and b)
it’s impossible anywayyou're not a Clinical Pharmacologist. 😉
Most cardiovascular drug interactions are due to their action rather than metabolism
I can't add anything medical beyond Superficial's amazing response.
But, I can be an Internet pedant. You said "I’ve just stumbled across a site on the internet suggesting" - so if you share the URL, we can look at the report and check out the science. Otherwise, we're guessing as to whether what you read holds water.
Stay safe dude.
I was hunting around to see if there was anything that would actually help to unclog arteries but fairly quickly discovered that that's not possible.
The page discussing caffeine (amongst other things) was https://www.thehealthy.com/heart-disease/foods-that-help-unclog-arteries/ and references this research (done on mice) - https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2004408
Mouse studies are interesting, but changing your diet/behaviour based on one is a stretch. Just the way the title of the other linked article is phrased would make me highly sceptical of its contents.
There are some hints of a beneficial metabolic effect for caffeine, and dark (high cocoa content) chocolate, in moderation, and I think 'in moderation' is key. Making significant changes to diet or intake of any particular part of it should be done in consultation with your cardiologist or his/her team.
Superficial's advice is excellent, as you'd expect.
If there are serious negative health consequences regarding caffeine, I'm well and truly screwed, when at home it's not unusual for me to a cup containing at 2-4 heaped teaspoons (4 is extreme, did this while trying to fight the extreme fatigue last year, presumably from Covid) roughly every hour or so until ~1600.
How do you drink it?
Black and no sugar, or full fat milk with sugar? Saying cup of coffee can mean many things.
Personally 2 x espresso or long blacks a day, decent beans and brew method and I'm happy, add milk to it and I just don't see the point.
My father in law who has had a quad bypass and a number of follow up treatments has been told to keep his intake to 1 to 2 cups a day though.
Not seeing a lot of quality trials here . Typically, like sports medicine trials, they tend to be under-powered and hoping for big effects. That's not really how medicine works. In double-blind randomized placebo-controlled trials we trust.
Two of interest were https://pubmed.ncbi.nlm.nih.gov/27749954/ showed no effect on arrhythmia in patients with moderate to severe LVEF. The second https://pubmed.ncbi.nlm.nih.gov/16624688/ showed in a proper placebo-controlled cross-over design vs. healthy subject controls, that caffeine prolongs exercise duration in heart failure patients. The dose was given IV (300 mg). That's a lot of coffee in one go. Absorption of caffeine is actually relatively slow - peak is about 40 minutes after dose. So this was given IV instead. You won't be taking that amount in one go any time soon.
And a small negative study on the effects of acute caffeine after two-week washout on angina in exercise https://pubmed.ncbi.nlm.nih.gov/2930092/ , and a second https://pubmed.ncbi.nlm.nih.gov/3969861/ . Remember theses studies are small (typically about 20 subjects) and are looking for big effects so should be interpreted with caution. The dose of caffeine, like the one above, is supra-therapeutic.
If cholesterol is a concern at all, bear in mind that coffee brewed with a paper filter has less than non-paper filtered. For example french press and espresso don't use paper filters so all the oils and fats get through, but a pourover or most drip made coffees use paper.