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Study Title and Description

Coffee, decaffeinated coffee, caffeine, and tea consumption in young adulthood and atherosclerosis later in life: the CARDIA 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 Coffee, decaffeinated coffee, caffeine, and tea consumption in young adulthood and atherosclerosis later in life: the CARDIA study.
Author JP Reis,CM Loria,LM Steffen,X Zhou,L van Horn,DS Siscovick,DR Jacobs,JJ Carr,
Country
Year 2010
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)? To determine the association of coffee, decaffeinated coffee, caffeine, and tea consumption in young adulthood with the presence and progression of coronary artery calcified (CAC) plaque and carotid intima-media thickness (CIMT) later in life.
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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) Study population: CARDIA is a multicenter longitudinal study of the development and determinants of cardiovascular disease over time in 5115 young adults initially aged 18 to 30 years from 1985 to 1986. Black and white adults were recruited from 4 US cities (Birmingham, Ala; Chicago, Ill; Minneapolis, Minn; and Oakland, Calif) with population-based samples approximately balanced within center by sex, age (18 to 24 or 25 to 30 years), race (white or black), and education (high school graduate or less or greater than high school graduate). Participants have been reexamined 2, 5, 7, 10, 15, and 20 years after baseline; and retention rates across examinations were 91%, 86%, 81%, 79%, 74%, and 72%, respectively. Clinical measurements: Blood pressure was measured on the right arm with a Hawksley random 0 sphygmomanometer (WA Baum Company, Copaigue, NY) in seated participants after a 5-minute rest. Three measurements were obtained at 1-minute intervals. Systolic and diastolic blood pressure measurements were recorded as the phase 1 and phase 5 Korotkoff sounds, respectively. Blood was drawn by venipuncture according to a standard protocol. Plasma high-density lipoprotein cholesterol and triglyceride concentrations were measured with an enzymatic assay by Northwest Lipids Research Laboratory (Seattle, Wash). Low-density lipoprotein cholesterol was derived by the Friedewald equation. Caffeine, coffee, tea, and other dietary information: The validated, interviewer-administered, quantitative CARDIA dietary history was previously described. Briefly, the CARDIA dietary history asked individuals to report foods eaten, including beverages, during the previous month using about 100 header questions (eg, "Do you eat meat?") followed by open-ended responses. The CARDIA dietary history was administered at years 0, 7, and 20. Participants were asked to report their usual coffee consumption, including cappuccino and flavored coffee, in fluid ounces or cups. Participants were also asked about usual tea consumption, either iced or hot. One cup of coffee or tea was considered approximately equal to 8 oz (237 mL). We created categories of coffee and tea consumption (in cups per day) based on the overall distribution of intake before examining associations with atherosclerosis. Total daily caffeine intake (in milligrams per day) was calculated from all caffeine-containing beverages and foods reported. Nutrients were derived from the food and nutrient content databases developed by the Minnesota Nutrition Coordinating Center. We used the distribution of all participants to define quintiles of caffeine intake. CT: Coronary artery calcified (CAC) plaque was measured at years 15 and 20 by computed tomography of the chest. Electron beam computed tomography (Chicago and Oakland centers) and multidetector computed tomography (Minneapolis and Birmingham centers) scanners were used to obtain 40 contiguous 2.5- to 3.0-mm-thick transverse images from the root of the aorta to the apex of the heart in 2 sequential scans. The presence of CAC was defined as a total calcified plaque score of greater than 0 AU, measured at year 15 or 20. For those with measures of CAC at both follow-up examinations (years 15 and 20), we also examined the association of coffee, caffeine, and tea consumption with 5-year progression of CAC, defined as incident CAC at year 20 or an increase in CAC score of 20 AU or greater. Carotid unltraonography: High-resolution B-mode ultrasonography was used to capture images of the bilateral common carotid (CC) and carotid bulb/internal carotid (IC) arteries using an ultrasound machine (Logiq 700; General Electric Medical Systems, Waukesha, Wis) at the year 20 examination.
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How many outcome-specific endpoints are evaluated? 2
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) Coronary artery calcified (CAC) plaque
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List additional health endpoints (separately). 2 Carotid intima-media thickness (CIMT)
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List additional health endpoints (separately).3
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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 Physiological
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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 CAC: Electron beam computed tomography (Chicago and Oakland centers) and multidetector computed tomography (Minneapolis and Birmingham centers) scanners were used to obtain 40 contiguous 2.5- to 3.0-mm-thick transverse images from the root of the aorta to the apex of the heart in 2 sequential scans. Carotid ultraonography: High-resolution B-mode ultrasonography was used to capture images of the bilateral common carotid (CC) and carotid bulb/internal carotid (IC) arteries using an ultrasound machine (Logiq 700; General Electric Medical Systems, Waukesha, Wis) at the year 20 examination.
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Caffeine (general)
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Coffee, Chocolate, energy drink, gum, medicine/supplement, soda, tea, other? Coffee, tea
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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.) 0 cups of caffeinated coffee/day. <26/6 caffeine intake/day. 0 cups tea/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) We used linear and logistic regression models to assess the significance level for linear trend across the categories of coffee for continuous and categorical characteristics, respectively, with adjustment for age, sex, and race. All continuous characteristics reflect the average of years 0 and 7, except age (year 0). Multivariable logistic regression models were used to estimate odds ratios and 95% CIs for the presence of CAC, CAC progression, and high CIMT associated with each level of caffeinated and decaffeinated coffee, caffeine, and tea consumption compared with the lowest level. Initial models minimally adjusted for age (in years), sex, race (white or black), smoking (current, former, or never), and center (Birmingham, Chicago, Minneapolis, or Oakland). Because coffee, caffeine, and tea intake may also be associated with other demographic, lifestyle, clinical, and dietary measures, fully adjusted models also accounted for educational attainment (less than high school, high school graduate, bachelor’s degree, or master’s degree or higher), physical activity (exercise units), alcohol intake (milliliters per day), body mass index, total energy (kilocalories per day), fruit and vegetable intake (servings per day), and whole and refined grain intake (servings per day). Tests for a linear trend were performed by entering the categorical coffee, caffeine, and tea variables separately into the multivariable models as ordinal terms. We also determined the association of coffee, caffeine, and tea consumption with the normalized composite CIMT expressed as a continuous variable in multivariable linear regression models. In addition, we examined associations with CIMT of the CC and IC separately as dichotomous outcome variables, defined by the 80th percentile; and as continuous natural logarithm–transformed variables. Because coronary atherosclerosis is greater among men than women and among white than black adults, and because coffee consumption varies across these subpopulations, we also explored the association between coffee and atherosclerosis within models stratified by sex and race. In addition, we examined whether the coffee-atherosclerosis relation was present among current, former, or never smokers because smoking is strongly associated with coffee intake and has been previously shown to modify this association. We formally tested for the presence of effect modification by introducing a multiplicative interaction term into each multivariable model.
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What conflicts of interest were reported? The authors had none to disclose.
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Refid 20616310
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What were the sources of funding? The CARDIA Study is conducted and supported by the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham (N01-HC95095 and N01- HC48047), the Kaiser Foundation Research Institute (N01- HC48050), Northwestern University (N01-HC48049), and the University of Minnesota (N01-HC48048).
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Results & Comparisons

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