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Coffee As a Risk Factor for Cardiovascular Diseases a Literature Study — Prashamsa Rijal HEL-3950 Master’S Thesis in Public Health June 2016

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Coffee As a Risk Factor for Cardiovascular Diseases a Literature Study — Prashamsa Rijal HEL-3950 Master’S Thesis in Public Health June 2016 Faculty of health sciences / Department of community medicine Coffee as a risk factor for Cardiovascular Diseases A Literature Study — Prashamsa Rijal HEL-3950 Master’s thesis in Public Health June 2016 Supervisor: Sidsel Graff-Iversen Co-supervisor: Marko Lukic Researcher, MD, Ph.D Researcher, MD, Post-Graduate University of Tromsø University of Tromsø 2 Preface The chosen topic, coffee consumption and its effects on cardiovascular health can be explained by a personal interest and the desire to understand in more depth, the effects coffee has on cardiovascular health. The reason for this interest is related to the worldwide popularity of coffee as a beverage, along with the conflicting results on the research based evidence done over the years about coffee’s effects on health. This interest has gradually grown as a result of the polarity of what coffee’s once illustrated effects on health was, to what it is today. Coffee has been gaining popularity as a protective entity in cardiovascular medicine. As a result, consumption of coffee is being encouraged through the media, especially over the internet on health and lifestyle websites. The thesis focuses and explores the conflicting evidence on the consumption of coffee over three decades, and the role of nicotine on the consumption of caffeine. The thesis also focuses on the incriminating evidences between the researches done in the past from the research done in the present. I think it is important to gain knowledge on whether there are negative side effects to excessive consumption of coffee, as well as to understand why brewing methods play an important role on the effects coffee has on cardiovascular health. Coffee is the most widely drunk beverage around the world, especially within Scandinavia;1 according to the statistics portal for data market, 1211 cups of coffee per capita was drank in Sweden alone in 2014, which was highest in the world after Finland at 1252 cups of coffee per capita. Norway came in at 5th place with 916 cups per capita and Denmark at 6th place with 845 cups per capita in 2014.1 3 The importance to explore the full effects of coffee related health problems, including brewing methods, is mainly due to the high consumption rate of coffee around the world. In the context of public health, knowing how a popular beverage such as coffee effects the cardiovascular risks, can eventually influence mortality rates related to cardiovascular problems in the future. 4 Acknowledgements I would like to take the opportunity to thank my supervisor Sidsel Graff-Iversen for having taken me as her student, and being patient with me while I worked on the thesis for the past year. I feel very grateful to have Marko as my co-supervisor, and feel my up most gratitude to him, who took his time from vacationing to give me feedback, and helped me throughout the process, whether it being searching papers from the main library to asking me about how the process was going every now and then. Lastly I would like to thank my family who encouraged me to not give up and put up with me during the process. Thank you so much! Prashamsa Rijal Mölndal 13/06/2016 5 6 Abstract The World Health Organization has claimed that non-communicable diseases kill 38 million people each year, and cardiovascular diseases (CVD) related deaths was the number 1 cause. Coffee is the most drank beverage all over the world. Researches in the past, had suggested that coffee consumption may increase risks of CVD. A literature study was performed using online search engines, google scholar and pubmed, in order to assess and compare evidence of the effects of coffee on cardiovascular health. Searches were done throughout the writing process. Filters were used to make the search process easier. Searches were performed according to publication dates between 1st January 1974 and 31st December 2015. Specific words like ‘coffee’, ‘risk’, ‘cardiovascular diseases’, ‘brewing methods’, were combined with ‘or’ and ‘and’ during the search process. Over the decades, researches acknowledged the consistency of coffee’s role in increasing the lipid profile in humans. However, they were able to claim that the brewing methods had an important role to the outcome of the results. In more recent times, it has been suggested that presences of antioxidants in coffee may have beneficial effects on over-all health of individuals. There has been extensive research done on coffee over the past 5 decades, and the effects it may have on health, with conflicting results. However, it seems that the quantity of consumption along with the methods of preparation may lead to different outcomes. 7 Keywords: Coffee Cardiovascular diseases Risks Homocysteine Cholesterol Lipid profile Kahweol Cafestol Myocardial infraction Abbreviations: CVD- Cardiovascular diseases WHO- World Health Organization NCD- Non-communicable diseases LDL - Low density lipoproteins HDL- High density lipoproteins MI- Myocardial infractions CHD- Coronary heart diseases 8 Lists of figures and tables Figure 1: Proportion of Global Deaths Under the Age of 70…………………………………….…13 Figure 2: Anatomy of The Heart…………………………………………………………………………………26 Figure 3: The Heart as a Two Way Pump……………………………………………………………………27 Figure 4: Paraxantine, theobromine and theophylline…………………………….…………………39 Figure 5: Caffeine pathway during metabolism………………………………………………………….40 Figure 6: : Molecular structure of Kahweol and Cafestol…………………………………………….42 Figure 7: Role of cafestol in increasing cholesterol levels……………………………………………44 Figure 8: Molecular Structure of Homocysteine………………………………………………………….46 Figure 9: Homocysteine’s place in metabolism……………………………………………………………48 Table 1: Value of cholesterol levels……………………………………………………………………………19 Table 2: The Tromsø studies..........................................................................................29 Table 3: The Tromsø study 1..........................................................................................30 Table 4: The Tromsø study 2..........................................................................................31 Table 5: The Tromsø study 3..........................................................................................33 Table 6: Coffee consumption and serum lipid concentrations in men with hypercholesterolaemia.................................................................................................34 Table 7: SHEEP VHEEP Study: rr for first nonfatal myocardial infarction......................55 Table 8: Study designs used in section 7.......................................................................64 9 10 Contents Preface……………………………………………………………………………………………………………………….3 Acknowledgements…………………………………………………………………………………………………….5 Abstract………………………………………………………………………………………………………………………7 1. Rational…………………………………………………………………………………………………………13 2. Objective……………………………………………………………………………………………………… 15 3. Thesis Structure………..…………………………………………………………………………………..15 4. Method and Materials…………………………………………………………………………………..16 4.1 Definitions and clarifications……………………………………………………………………16 4.2 Literature Search Strategy……………………………………………………………………….21 4.3 Materials………………………………………………………………………………………………….23 5. Cardiovascular diseases and Health……………………………………………………………….25 6. Introduction to the Tromsø Study.....................................................................28 7. The Discovery of the effects of coffee as a cardiovascular disease risk factor……………………………………………………………………………………………………………..33 7.1 Mechanism of Action of Caffeine in the Human Body………………………………38 7.2 How cafestol and kahweol raise serum cholesterol………………………………….41 7.3 Homocysteine; what is it; how is it involved in the metabolic process; And how is it related to cardiovascular diseases and coffee?......................46 8. Results: Recent research on coffee and cardiovascular health……………………….51 9. Combined effect of smoking and coffee on the cardiovascular system…………..61 10. Methodological limitations……………………………………………………………………………..63 11. Summary and Conclusion………………………………………………………………………………..68 REFERENCES……………………………………………………………………………………………………72 11 Contents Supplementary Material...................................................................................................78 12 1. Rational Cardiovascular diseases are among the four major non-communicable diseases (NCD) responsible for leading causes of death worldwide. According to the World Health Organization (W.H.O), 52% of all death in 2012 were NCD related, and 37% of the 52% of the lives claimed were due to Cardiovascular diseases.9 Fig 1: Proportion of global deaths under the age of 70 years, by cause of death. Estimates from 2012. (WHO. Global status report on noncommunicable diseases. 2014. P10; fig 1.3. Available from: http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_eng.pdf?ua=1) 13 As reported by the W.H.O, Cardiovascular diseases (CVDs): are the number 1 cause of the global deaths; 17.5 million people were estimated to have died in 2012 due to CVD related causes, of which 7.4 million were due to coronary heart disease, and the remaining 6.7 million were cerebrovascular accidents (CVA). Preventable. Population with high risk factors can be managed appropriately if they are detected early on.10 Through the years, risk factors for cardiovascular diseases have been identified as preventable and non-preventable. Among preventable causes, cigarette smoking, alcohol use, inactivity, and general life style choices were attributable to the significant portion of CVD related
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