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Study Title and Description

Caffeinated coffee consumption, cardiovascular disease, and heart valve disease in the elderly (from the Framingham Study).



Key Questions Addressed
1 For [population], is caffeine intake above [exposure dose], compared to intakes [exposure dose] or less, associated with adverse effects on cardiovascular outcomes?
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Primary Publication Information
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TitleData
Title Caffeinated coffee consumption, cardiovascular disease, and heart valve disease in the elderly (from the Framingham Study).
Author JA Greenberg,G Chow,RC Ziegelstein,
Country
Year 2008
Numbers

Secondary Publication Information
There are currently no secondary publications defined for this study.


Extraction Form: Cardiovascular Design
Design Details
Question... Follow Up Answer Follow-up Answer
What outcome is being evaluated in this paper? Cardiovascular
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What is the objective of the study (as reported by the authors)? The relation between caffeinated coffee consumption and heart disease morbidity and mortality is of great interest given the extensive use of this beverage. A recent prospective epidemiologic study found a strong protective association in elderly subjects without moderate to severe hypertension in the NHANES. To test this association in the Framingham Heart Study population, in which cardiovascular risk factors and health behaviors were carefully documented, Cox regression analyses were conducted for 1,354 subjects aged 65.4 to 96.6 years at study entry.
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Provide a general description of the methods as reported by the authors. Information should be extracted based on relevance to the SR (i.e., caffeine related methods) Population: The Framingham Heart Study began in 1948, when researchers recruited 5,209 men and women aged 30 to 62 years from Framingham, Massachusetts. Physical examinations, lifestyle interviews, and laboratory tests have been conducted every 2 years since 1948. The cohort has also been followed up for morbidity and mortality. We selected examination 19 in Framingham as follow-up baseline because subjects were all >/= 65 years old and examination 19 was the first in which caffeinated coffee was distinguished from decaffeinated coffee. There were 1,541 subjects at examination 19. Subjects with any missing data were excluded from our survival analyses. After exclusions, there were 1,354 subjects aged 65.4 to 96.6 years in examination 19 and 210 CVD and 118 coronary heart disease (CHD) deaths during the follow-up period between examinations 19 and 25, the last examination for which data were available. The follow-up period lasted an average of 10.1 years for censored subjects. We studied cardiovascular events and mortality separately. Cardiovascular events included CHD events, defined by the Framingham researchers to include myocardial infarction, coronary insufficiency, and angina pectoris. Cerebrovascular disease (CBD) events included atherothrombotic cerebral infarction, transient ischemic attack, cerebral embolism, intracerebral hemorrhage, and subarachnoid hemorrhage or other cerebrovascular accident. CVD events included CHD, CBD, intermittent claudication, and congestive heart failure. Heart valve disease included aortic and mitral valve disease based on clinical diagnostic impressions of the Framingham researchers. Cardiovascular mortality included CHD, CBD, or CVD mortality defined as deaths from CHD, CBD, or CVD events, respectively. Antihypertensive medication use was determined by Framingham researchers. Body mass index was calculated as measured body weight in kilograms divided by the square of measured height in meters. BP was the average of 2 measurements made by a physician. To assess the effects of BP level, we created BP subgroups using the definitions of stage 1 and 2 hypertension in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Food and beverage intake information: Beverage intake was determined from food-frequency questions at examination 19. Subjects were asked how many cups each day of caffeinated coffee, decaffeinated coffee, caffeinated tea, and decaffeinated tea and how many 12-oz cups each day of caffeinated colas and decaffeinated colas they drank. We used any and no cups each day as consumption categories in our survival analyses because Framingham subjects did not drink enough to allow for meaningful statistical analyses at higher consumption levels. Framingham researchers assessed daily hours of different levels of activity at examination 19. Based on MET intensity levels published by Ainsworth et al. and the model proposed by Pate et al. for classifying the MET intensity of physical activities, we used the following formula to convert Framingham data to MET: 0.9 x (daily hours of sleep) + 1.5 x (daily hours of sedentary activity) + 2.0 x (daily hours of slight activity) + 3.5 x (daily hours of moderate activity) +10.0 x (daily hours of heavy activity). Alcohol intake in ounces/week was estimated by Framingham researchers based on questions about frequency of consumption of beer, wine, and cocktails.
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How many outcome-specific endpoints are evaluated? 3
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) Coronary heart disease (CHD)
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List additional health endpoints (separately). 2 Cerebrovascular disease (CBD)
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List additional health endpoints (separately).3 Cardiovascular disease (CVD)
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List additional health endpoints (separately).4
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List additional health endpoints (separately).5
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List additional health endpoints (separately).6
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Clinical, physiological, other Clinical
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What is the study design? Cohort
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Randomized or Non-Randomized?
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What were the diagnostics or methods used to measure the outcome? Objective
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Optional: Name of Method or short description Appears that CVD, CHD, and CBD were diagnosed by Framingham researchers.
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Caffeine (general)
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Coffee, Chocolate, energy drink, gum, medicine/supplement, soda, tea, other? Coffee
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Measured or self reported? Self-report
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Children, adolescents, adults, or pregnant included? Adults
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What was the reference, comparison, or control group(s)? (e.g. high vs low consumption, number of cups, etc.) Nondrinkers were referents; 0 cups of caffeinated coffee/day.
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What were the listed confounders or modifying factors as stated by the authors? (e.g. multi-variable components of models.  Copy from methods) Cox proportional hazards regression was used to calculate hazard ratios (HRs) of CVD mortality and morbidity in each category of beverage intake and adjust HRs for the effects of covariates. The -2 log likelihood test was used to compare the fit of alternative models. Log-minus-log plots and tests of interaction between caffeinated coffee intake level and time provided no evidence against proportionality assumptions. The covariates used were age (quartiles <70, 70 to 73, 74 to 78, and >/=79 years), smoking (nonsmoker, smoker), gender, exercise level (quartiles of MET), alcohol consumption (0, 1 to 2, and >/= 3 oz/week), body mass index (<23, 23 to 25, 25 to 29, and >/=30 kg/m2 ); history of CVD (yes/no); marital status (single, married, and widowed, divorced, or separated), antihypertensive medication use (yes/no), and BP level (no hypertension, systolic BP <120 mm Hg and diastolic BP <80 mm Hg; prehypertension, systolic BP 120 to 139 mm Hg, diastolic BP 80 to 89 mm Hg, or both; stage 1 hypertension, systolic BP 140 to 159 mm Hg, diastolic BP 90 to 99 mm Hg, or both; and stage 2 hypertension, systolic BP >/=160 mm Hg, diastolic BP >/=100 mm Hg, or both). Logistic regression was used to assess the association between beverage intake at examination 19 and the diagnosis of heart valve disease at examination 25.
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What conflicts of interest were reported? No mention was made of specific conflicts. Authors stated, "This report was prepared using a limited access data set obtained from the NHLBI and does not necessarily reflect the opinions or views of the Framingham Study or the NHLBI. We appreciate being able to obtain and work with the Framingham data."
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Refid 19026304
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What were the sources of funding? Authors report no specific funding individually. They state, "The Framingham Heart Study was conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the Framingham Study Investigators."
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Results & Comparisons

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