Moderate coffee consumption improves aortic distensibility in hypertensive elderly individuals. Ikaria study

Transcription

1 Moderate coffee consumption improves aortic distensibility in hypertensive elderly individuals. Ikaria study Christina Chrysohoou, Kyriakos Dimitriadis, Dimitris Maragiannis, Dimitris Roussos, George Lazaros, Marina Zaromitidou, Georgia Vogiatzi, Gerasimos Siasos, Christos Pitsavos, Christodoulos Stefanadis 1 st Cardiology Clinic University of Athens, Greece

2 Declarations Conflict of interest: None Funding: 1 st Cardiology clinic University of Athens, Greece

3 Coffee drinking Coffee is among the most commonly consumed beverages around the Western world. Nearly 50% of people over 18 years of age drink coffee every day Men drink as much coffee as women, with each consuming an average of 1.6 cups per day National Coffee Association and The Specialty Coffee Association of America

4 Types of coffee Brewed coffee is the richest in caffeine content (135 mg per 8 oz), while percolated roasted and ground coffee contains 74 mg of caffeine and drip roasted and ground coffee 112 mg per 5 oz respectively Greek coffee contains mg/100ml cafestol and mg/100 ml karweol, in contrast with filtered coffee which contains 0-0.1mg/100 ml of these diterpenes Cornelis MC Curr Opin Lipidol 2007; 18(1):13-9 Ranheim T. Mol Nutr Food Res 2005;49(3):

5 Coffee consumption and human heath. Beneficial or detrimental? The effect of coffee consumption on human health, and especially CVD, has been evaluated in many studies, with controversial results. Potential mechanisms that coffee drinking may affect CVD risk are due to the increase of blood pressure lipids inflammation markers and the detrimental effect on aortic stiffness and wave reflections Vlachopoulos et al., Am J Clin Nutr Cruchten ST, et al., Drug Metab Dispos. 2010

6 Coffee and human health all these data are mainly based on middleaged populations, where the CVD burden is low, while among the elderly, where the burden of disease is high and due to the aging the elastic properties of aorta are diminished and the nutritional status and needs have been modified due to agerelated biological and socioeconomic changes, the information about the effect of coffee consumption on elderly individuals health is sparse.

7 With aging, arteries progressively stiffen, dilate, and lengthen. Distensibility is a measure of the elasticity of arteries, and low levels have long been recognised as an indicator of atherosclerosis and a reliable predictor of future cardiovascular events. By increasing the load on the heart, hypertension leads to vascular changes and neuro-hormonal activation which causes increases in vascular stiffness and reduced elasticity.

8 Aim of the study As the results of several studies about the role of coffee on cardiovascular system are conflicting, we evaluated in this work the impact of daily coffee consumption on echocardiographic indices of aortic distensibility in hypertensive elderly habitants of the Ikaria island. We focused our analysis in the hypertensive's sub-group because the pressor response to caffeine seems to be more pronounced in hypertensive or hypertension-prone subjects than in normotensive ones.

9 The Blue Zones Loma Linda, Mexico Nicoya, Costa Rica Sardinia, Italy Okinawa, Japan have the largest prevalence of long-livers universally

10 Ikaria island joined the Blue Zones in 2009 «For 1000s of years the climate, therapeutic thermal springs and topography of Ikaria have made it an ideal place for people from around the world to convalesce, be healed and relax their mind, body and spirit». These same factors in combination with the traditional ways of living in Ikaria have also resulted in long life and well above average age expectancy for the islands' residents. Dan Buettner

11 The IKARIA study Design: cross-sectional Sampling: volunteering, on feasibility basis Duration of sampling: June to October 2009 Sample size: 673 elderly (mean age 75 ±6.5, 49% males) and 657 below the age of 65 (mean age 54±7, 46% males) permanent inhabitants of Ikaria island. Measurements: >300 demographic, lifestyle, behavioural, dietary, clinical and biochemical variables have been recorded using face-to-face interviews and standard procedures. Bioethics: IRB, written consent by the participants

12 Methods Dietary assessment was based on a validated semi-quantitative food frequency questionnaire (FFQ) validated in our Institution Tyrovolas S,, Panagiotakos DB: the MEDIS-FFQ. J Nutr Elderly 2010 Coffee drinking assessment: All participants were asked about their usual frequency and type of coffee consumption (i.e. never, < 1 cup per week, 1-2 cups/day, 3-5 cups/day and >5 cups/day) over the previous year. For the analysis, all types of coffee reported (instant, boiled coffee, cappuccino or filtered) were adjusted for one cup of 150 ml coffee and a concentration of 28 mg caffeine per 100 ml. one cup of coffee was equivalent to 450 ml of brewed coffee or 300 ml of instant coffee Bunker ML, McWilliams M. Caffeine content of common beverages. J Am Diet Assoc

13 Methods The consumption of decaffeinated coffee was not analysed because this product was not frequently consumed in the investigated Island. Overall assessment of dietary habits were evaluated through a special diet score (MedDietScore, range 0-55), which assesses adherence to the Mediterranean dietary pattern Panagiotakos DB, Pitsavos C, Stefanadis C ; The accuracy of the MedDietScore. Prev Med

14 Aortic distensibility Aortic distensibility was calculated using the equation: 3.14 x (AoS-AoD) x AoD/ (2x (SBP-DBP)); where AoS and AoD are the systolic and diastolic diameters of aortic root (3 cm from the valve), and SBD and DBP are the systolic and diastolic blood pressure levels measured in sitting position at the end of the interview Measurements of systolic (S) and diastolic (D) diameters of the ascending aorta are shown on the M mode tracing obtained at a level 3 cm above the aortic valve. Stefanadis C,et al.. J Cardiol1988;18:78 82.

15 Characteristics of the elderly participants in the IKARIA Study Men n = 330 Women n = 343 p Age (years) Current smokers (%) Education level (years of school) Body mass index (Kg / m 2 ) IPAQ score Hypertension (%) Hypercholesterolemia (%) Diabetes mellitus (n, %) Obesity (%) Cardiovascular disease MedDietScore Systolic Blood Pressure (mm Hg) Diastolic Blood Pressure (mm Hg)

16 The sample of this work In this work 485 elderly hypertensive individuals were studied: mean age 76±6 yrs, 47% males

17 Results MAIN FINDINGS

18 Distribution of coffee consumption Coffee was a widespread beverage in our sample, as it is in most of the world. Almost 9 / 10 elderly participants (i.e., 88%) consumed at least 1 cup of coffee/day, the majority of them (i.e., 92%) consumed Greek type, unfiltered, brewed coffee, mainly, in the morning (before work) or early in the afternoon (after work) socializing, with friends in cafeterias or with family at home relaxing and discussing daily matters

19 Distribution of coffee consumption Average consumption: 1.4 cups/day Duration of consumption: Life long Frequency of consumption: 33% consumed 0-1 cups/day, 56% consumed 1-2 cups/day 11% consumed 3+ cups/day

20 Demographic, clinical and biochemical characteristics of the participants according to coffee consumption category 0-1 cups 1-2 cups 3 and more cups P-value Age 77±4 75±5 74± Gender (% males) BMI (kg/m 2 ) 29±5 28.8±4.5 29± Years of education 7±3 8±4 7± Current smoking habits (%) <0.001 Cardiovascular disease (%) Hyperlipidaemia (%) Diabetes Mellitus (%) SBP (mm Hg) ±19 151± DBP (mm Hg) 80±13 82±12 83± Aortic distensibility (cm 2 /mmhg) 1.03± ± ± MedDietScore (0-55) 35±3 35±3 34±2 0.76

21 b-coef in cm2/mmhg Coffee consumption and aortic distensibility 0,6 0,5 0,4 0,3 0,2 P=0.15 P=0.04 0,1 0-0,1 P= cups/d vs. never 1-2 cups/d vs. never 3+ cups/d vs. never Results from GLM after adjusting for age, gender, smoking, BMI, education, DM, and physical activity status.

22 Discussion Moderate coffee consumption improved aortic distensibility, Pathophysiological mechanisms because of the polyphenolic compounds found in coffee, especially in traditional Greek blends that are high in diterpenes such as cafestol and kahweol.

23 Discussion Pathophysiological mechanisms The effect of chlorogenic acid has been reported to be associated with NO, as caffeic and ferulic acids appear to improve vascular function by reducing oxidation and enhancing the bio-availability of NO. However, in hypertensive patients the balance between NO and superoxide production is already damaged, so the impact of the beneficial compounds present in coffee is possibly not strong enough to offer a protective effect through increased consumption. Ochiai R, et al. Hypertens Res 2004;27: Hamer M.J Hum Hypertens 2006;20: ATTICA study. Am J Clin Nutr 2004;80:862-7

24 Limitations cross-sectional study recall biases, particularly in the assessment of dietary habits, people living in the Mediterranean islands are not a representative sample of the total Greek or European population, they could be considered a population that has been a closed population for a long time and, therefore, unaffected by the influence of westernized habits. increased consumption of coffee is associated with unhealthy behaviors, such as physical inactivity, unhealthier dietary habits and smoking. these potential confounders were statistically controlled but, as always, residual confounding cannot be explained. The majority of the participants consumed Greek coffee, which meant that the association of other coffee types could not be evaluated in our study.

25 Conclusions Drinking coffee, in moderation, should be encouraged, even in elderly hypertensive subjects, as it seems that may improve arterial aging.

26 Aknowledgements We are particularly grateful to the men and women from the island of Ikaria, who participated in and collaborated on this survey. We also wish to express our gratitude to the following: Mr Karoutsos (Mayor of Raches), Mr Stamoulos (Mayor of Evdilos), Mr Teskos (Mayor of St Kyrikos) Dr Katte K, Dr Mylonakis B, Mrs S Spanou (from the Health Center of Eudilos) Dr S Mamatas, Mr Skaros (from General Hospital of St Kyrikos)

27 The IKARIA Study group Head: Prof C. Stefanadis and Assoc Prof C. Pitsavos Investigators: C. Chrysohoou, J Skoumas, G Lazaros, G Siassos, M Kambaxis, V Metaxa, D Tsiachris, K Dimitriadis, D Roussos, S Athanassopoulou, D Maragiannis, M Zaromytidou, A Margazas, J Andreou, A Patialakas, J Felekos, D Aragiannis, P Kourkouti, E Giakoumi, S Lagoudakou, E Poulidakis, M Striggou, B Psaroudaki, C Masoura, E Economou, C Zisimos, E Christoforatou, A Valatsou, S Plytaria, S Zoulia, S Kyvelou, E Gialafos, G Marinos, G Vogiatzi, C Kosifa, S Vogiatzoglou. G Triantafyllou,

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