IS COFFEE SAFE AFTER A HEART ATTACK?
Drinking coffee soon after a heart attack is often discouraged by cardiologists and internists, out of concern that caffeine, which is present in coffee in moderate levels, and which acts as a cardiovascular stimulant, may increase the risk of additional cardiac strain or heart attack. For coffee lovers, however, the thought of discontinuing consumption of their favorite beverage after experiencing a heart attack may be disconcerting. Unfortunately, although coffee consumption has been studied rather extensively regarding its possible association with the development of heart disease, there is not a great deal of evidence out there in terms of its safety in patients who already have heart disease, and who have recently experienced a heart attack.
A new Italian public health study, just published in the journal Circulation , evaluated more than 11,000 adults who reported a heart attack within the previous three months, and assessed their intake of coffee throughout the duration of the study. Coffee consumption was categorized as follows: never/almost never, less than 2 cups per day, 2 to 4 cups per day, and more than 4 cups per day. After an average of more than three years of follow-up, the risk of heart attack, death due to heart attack, and stroke was calculated according to the level of coffee consumption in this population of adults with a history of recent heart attack.
Coffee lovers will be relieved to know that, in this study, there appeared to be no association between coffee consumption and the subsequent risk of additional heart attacks, death due to heart attacks, or stroke. This reassuring data follows multiple prior studies suggesting that moderate coffee consumption may also decrease the risk of diabetes, as well.
Despite the reassuring results of this epidemiological study, all patients with a history of coronary artery disease (including recent heart attack) should discuss the routine use of dietary stimulants, such as coffee and tea, with the physician who is managing their cardiac disease.
IMPACT OF DIVORCE ON THE ENVIRONMENT
Certainly, the enormous social and economic consequences of divorce have already been extensively studied and reported upon. A new study in the Proceedings of the National Academy of Sciences , however, puts a new spin on the consequences of divorce in our society. In this study, statistics related to divorced and non-divorced households in 12 countries around the world were analyzed, and the impact of divorce on the environment was assessed, with some rather interesting findings.
First of all, and not really surprisingly, divorced households were smaller than married households (27 to 41% smaller, in fact, among the various countries studied). Somewhat counter-intuitively, however, in the United States, divorced households spent 46% more on electricity, and 56% more on water, than married households; and divorced households also tended to have more rooms-per-person than their married household counterparts. Looking at the United States in particular, the authors of this study calculated that if the number of rooms-per-person, water usage, and electricity usage among the divorced households had been on par with married households then, more than 38 million rooms, 74 billion kilowatt-hours of electricity, and 627 billion gallons of water could have been conserved in 2005 alone, based upon the prevalence of divorce in the US that year!
While divorced households used 42 to 61% more resources per person than married households, remarriage within divorced households appeared to reduce per person resource usage back to the levels associated with the never-divorced married households. The authors, therefore, conclude that divorce leads to a resource-inefficient lifestyle, which can be rectified either by avoiding divorce or by remarrying. One might therefore assume that maintaining the integrity of marriage and the nuclear family is, in general, an environmentally sound method of conserving precious natural resources.
HIGH BLOOD PRESSURE & THE RISK OF DEMENTIA
The role of chronic high blood pressure on brain function is an area of intense study. There is a great deal of research showing that poorly-controlled hypertension can lead to mini-strokes that, over time, can produce significant dementia or other milder forms of cognitive impairment. The relationship between ongoing hypertension and the risk of developing Alzheimers disease, the most common cause of severe dementia, is less clear based upon published research findings.
According to an independent living community with Alzheimers patients, mild cognitive impairment, which is considered an intermediate stage of dementia, may be one of the earliest signs of impending Alzheimers disease. A new study in the Archives of Neurology followed 918 adults for nearly 5 years, and assessed the relationship between chronic hypertension and the development of mild cognitive impairment. All of these study volunteers were free of signs of cognitive impairment when they initially volunteered for this clinical research study.
In this study, the presence of hypertension was associated with a 40% relative increase in the risk of mild cognitive impairment, after adjusting for age, sex, and other factors thought to be related to the risk of developing mild cognitive impairment. Interestingly, the type of cognitive dysfunction that appeared to be associated with chronic hypertension was in the area of so-called executive ability, which is believed to include temporary memory that is set aside in the brain for decision-making, planning, troubleshooting complex or dangerous situations, and responding to situations that are either novel or that involve habitual behaviors. Chronic hypertension did not, however, appear to be linked to increased difficulties with memory formation or retrieval, or with language capability, in this study. The studys authors conclude that the prevention, or aggressive treatment, of hypertension may subsequently reduce the risk of mild cognitive impairment.
EMOTIONAL VITALITY & THE RISK OF HEART DISEASE
Much has been written about the risk of heart disease as a function of personality type. The classic Type A personality, which is associated with traits such as impatience, a constant sense of urgency, and a highly goal-oriented lifestyle, has been linked to an increased risk of cardiovascular disease when compared to the more patient and relaxed Type B personalities among us. A new study in the Archives of General Psychiatry looks at the impact of emotional vitality on the incidence of coronary artery disease among more than 6,000 adult men and women who participated in the National Health & Nutrition Examination Survey.
Emotional vitality is defined as a collection of generally positive psycho-emotional traits that includes a sense of positive well-being, a sense of personal energy, and a tendency to confront stimuli (both good and bad) with appropriate and measured emotional responses. The participants in this public health observational study were followed for an average of 15 years after completing the initial survey. Based upon hospital records and death certificates, the authors found that those individuals who scored highly in terms of emotional vitality were 19% less likely, in terms of relative risk, to be diagnosed with coronary artery disease when compared to subjects who scored poorly in terms of their level of emotional vitality. While the authors found that higher levels of emotional vitality were also associated with increased levels of heart-healthy behaviors, the favorable effect of emotional vitality on cardiac health persisted even when the effects of heart-healthy behaviors (or the lack thereof) were controlled for.
There is a growing body of research linking emotional and psychological health with the functions of critical body systems, including the immune system, the GI tract, and the heart. It may well be that our sense of personal well-being is associated with hormonal and immunological factors which may help to maintain our hearts in a healthy state, while negative emotional factors may send destructive signals to our heart and other vital organs. Mind and body, it appears, are more closely connected than was previously thought to be the case.
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity.
Dr. Robert Wascher is an oncologic surgeon, professor of surgery, and a widely published author. He is the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center. Send your feedback to Dr. Wascher at rwascher@doctorwascher.net
Copyright 2007. Robert A. Wascher, MD, FACS. All rights reserved .
