2.1 Chocolate as an anti-inflammatory agent
- Kim J.E.
- Son J.E.
- Jung S.K.
- Kang N.J.
- Lee C.Y.
- Lee K.W.
- et al.
2.2 Cocoa and cardiovascular risk factors
|Chocolate, Reference||Study||Exposure||Endpoint||N. cases/N. total||Adjusted RR or OR (95% CI)||Summary|
|Buijsse B, 2006 |
|Zutphen Elderly Study, prospective study||Cocoa intake, highest vs lowest tertile||Cardiovascular mortality||152/470||0.50 (0.32–0.78)||In elderly men, inverse association between cocoa intake and cardiovascular and all-cause mortality|
|Cocoa intake, highest vs lowest tertile||All cause mortality||162/470||0.52 (0.38–0.71)|
|Gallus S, 2009 |
|Italy, case-control study||≥3 chocolates/day vs <2 chocolates/day||AMI||760/1442||0.23 (0.08–0.65)||Eating ≥3 chocolates/day is inversely associated with nonfatal AMI|
|Janszky I, 2009 |
|Stockholm Heart Epidemiology Program, population-based inception cohort study||Chocolate consumption, 50 g; ≥2/week vs no consumption||Cardiac mortality, diabetes free post AMI||107/1169||0.34 (0.17–0.70)|
|Total mortality, diabetes-free post AMI||210/1169||0.94 (0.58–1.53)|
|Recurrent AMI, diabetes-free post AMI||250/1169||0.86 (0.54–1.37)|
|Congestive heart failure, diabetes-free post AMI||279/1169||0.78 (0.52–1.16)||Inverse association with cardiac mortality in post-AMI patients|
|Stroke, diabetes-free post AMI||111/1169||0.62 (0.33–1.16)|
|Any non-fatal event, diabetes-free post AMI||471/1169||0.82 (0.59–1.14)|
|Buijsse B, 2010 |
|EPIC-Potsdam Study, prospective study||Chocolate intake, highest vs lowest quartile||Myocardial infarction||166/19,357||0.73 (0.47–1.15)||Reduced CVD risk according to chocolate consumption partly due to its BP-lowering effect|
|Chocolate intake, highest vs lowest quartile||Stroke||136/19,357||0.52 (0.30–0.89)|
2.3 Evidence from epidemiology
|Coffee, Reference||Study||Exposure||Endpoint||N. cases/N. total||Adjusted RR or OR (95% CI)||Summary|
|Grobbee DE, 1990 |
|The Health Professional Follow-up Study, longitudinal study||Total Coffee consumption ≥4 cups/day vs none||Nonfatal MI, CHD death, CABG, PTCA, Stroke||Both caffeine and caffeinated coffee intake do not increase CHD and stroke risk|
|Nonfatal MI and CHD death||221/45,589; Men||1.08 (0.72–1.60)|
|CABG and PTCA||136/45,589; Men||0.95 (0.56–1.61)|
|Total CHD||357/45,589; Men||1.00 (0.73–1.37)|
|Fatal and nonfatal stroke||54/45,589; Men||0.48 (0.18–1.31)|
|Total CVD||408/45,589; Men||0.90 (0.67–1.22)|
|Caffeinated coffee consumption ≥4 cups/day vs none||Nonfatal MI and CHD death||221/45,589; Men||1.01 (0.62–1.65)|
|CABG and PTCA||131/45,589; Men||0.66 (0.32–1.34)|
|Total CHD||342/45,589; Men||0.84 (0.56–1.25)|
|Fatal and nonfatal stroke||52/45,589; Men||0.28 (0.06–1.26)|
|Total CVD||390/45,589; Men||0.74 (0.50–1.09)|
|Decaffeinated coffee consumption ≥4 cups/day vs none||Nonfatal MI and CHD death||214/45,589; Men||1.55 (0.85–2.81)||Decaffeinated coffee moderately increases CHD risk|
|CABG and PTCA||132/45,589; Men||1.74 (0.81–3.73)|
|Total CHD||346/45,589; Men||1.63 (1.02–2.60)|
|Fatal and nonfatal stroke||51/45,589; Men||1.16 (0.26–5.10)|
|Total CVD||394/45,589; Men||1.58 (1.01–2.48)|
|Myers MG, 1992 |
|11 Prospective Studies (cohorts without history of MI), meta-analysis||Coffee intake, ≥6 cups/day vs ≤1 cup/day||Coronary events||1.09 (0.97–1.22)||No association between coffee consumption and CHD|
|Later Cohort||1.27 (1.17–1.39)|
|Earlier Cohort||0.92 (0.80–1.06)|
|Pooled cohort||1.18 (1.03–1.34)|
|Kawachi I, 1994 |
|8 case-control and 15 cohort studies, meta-analysis||Coffee drinking, ≥5 cups/day vs none||CHD||Pooled case-control||1.63 (1.50–1.78)||Increased CHD risk according to increased coffee drinking|
|Pooled cohort||1.05 (0.99–1.12)||Weak CHD risk in habitual coffee drinkers|
|Woodward M, 1999 |
|Scottish Heart Health Study, cohort study||Coffee consumption ≥5 vs none||CHD||?/5645; Men||0.68 (0.37–1.24)||Moderate benefit from coffee consumption|
|CHD||?/5800; Women||0.55 (0.18–1.66)|
|Hammar N, 2003 |
|The SHEEP and the VHEEP Study, population-based case-control study||Consumption >9 dL filtered coffee/day vs ≤3 dL/day||First nonfatal MI||1171/1813; Men||1.93 (1.42–2.63)||Incidence of first nonfatal MI 1.4 times higher in men drinking boiled coffee vs men drinking filtered coffee, with an even higher risk for women|
|Consumption >9 dL mixed coffee/day vs ≤3 dL/day||2.24 (1.08–4.64)|
|Consumption >9 dL boiled coffee/day vs ≤3 dL/day||2.20 (1.17–4.15)|
|Consumption >9 dL filtered coffee/day vs ≤3 dL/day||First nonfatal MI||472/854; Women||1.43 (0.81–2.54)|
|Consumption >9 dL mixed coffee/day vs ≤3 dL/day||2.91 (0.28–29.69)|
|Consumption >9 dL boiled coffee/day vs ≤3 dL/day||4.97 (0.55–44.73)|
|Boiled vs filtered coffee||1171/1813; Men||1.41 (1.07–1.85)||Boiled coffee increases the occurrence of first nonfatal MI|
|Boiled vs filtered coffee||472/854; Women||1.63 (1.04–2.56)|
|Panagiotakos DB, 2003 |
|The CARDIO2000, case-control study||Very heavy coffee drinkers (>600 mL/day) vs none||ACS||848/1078||3.10 (1.82–5.26)||J-shaped relation between coffee intake and ACS risk|
|Happonen P, 2004 |
|The Kuopio Ischaemic Heart Disease Risk Factor Study, prospective study||Moderate drinkers vs heavy drinkers (≥814 mL/day)||Acute coronary events (MI or coronary death)||269/1971; Men||1.43 (1.06–1.94)||Heavy coffee drinking raises the risk of acute MI or coronary death|
|Mukamal KJ, 2004 |
|Determinants of Myocardial Infarction Onset Study, inception cohort study||Coffee consumption >14 cups/week vs none||Mortality after AMI||315/1902||1.13 (80–1.60)||No association between coffee consumption and post-infarction mortality|
|Coffee consumption >14 cups/week vs none||Deaths within 90 days||79/1902||0.38 (0.17–0.86)|
|Coffee consumption >14 cups/week vs none||Deaths beyond 90 days||236/1902||1.52 (1.03–2.26)||Time variation in coffee effect|
|Andersen LF, 2006 |
|Iowa Women's Health Study, prospective study||Regular coffee ≥6 cups/day vs none||Death due to CVD, postmenopausal||1411/41,836||0.92 (0.74–1.14)|
|Decaffeinated coffee ≥6 cups/day vs none||Death due to CVD, postmenopausal||1411/41,836||0.99 (0.70–1.39)||U-shaped associations (death from CVD and total mortality)|
|Regular coffee ≥6 cups/day vs none||Total mortality, postmenopausal||4265/41,836||0.95 (0.84–1.07)|
|Decaffeinated coffee ≥6 cups/day vs none||Total mortality, postmenopausal||4265/41,836||0.94 (0.78–1.14)|
|Lopez-Garcia E, 2006 |
|Prospective cohort study||Coffee intake, ≥6 cups/day vs <1 cup/month||CHD|
|CHD||2173/44,005; Men||0.72 (0.49–1.07)|
|2254/84,488; Women||0.87 (0.68–1.11)||No indication that coffee (or caffeine) intake increases CHD|
|Caffeine intake, ≥6 cups/day vs <1 cup/month||CHD||2173/44,005; Men||0.97 (0.84–1.11)|
|CHD||2254/84,488; Women||0.97 (0.85–1.11)|
|Azevedo A, 2006 |
|Community-based case-control study||Regular ever coffee drinkers||AMI||290/364; Men||0.5 (0.3–1.1)||Significant↓MI in men with no family history of AMI; non significant ↑ MI in men withfamily history of AMI|
|Kleemola P, 2006 |
|Finnish men and women, prospective study||Coffee consumption >7 cups/day vs 1–3 cups/day||Non fatal MI||891/10,075; Men||0.79 (0.64–0.98)|
|Coffee consumption >7 cups/day vs 1–3 cups/day||CHD mortality||891/10,075; Men||1.22 (0.90–1.65)|
|Coffee consumption >7 cups/day vs 1–3 cups/day||All cause mortality||1201/10,075; Men||1.01 (0.84–1.22)||Coffee drinking is not associated with CHD risk and death|
|Coffee consumption >7 cups/day vs 1–3 cups/day||Non fatal MI||319/10,387||0.93 (0.63–1.36)|
|Coffee consumption >7 cups/day vs 1–3 cups/day||CHD mortality||99/10,387||0.57 (0.28–1.16)|
|Coffee consumption >7 cups/day vs 1–3 cups/day||All cause mortality||444/10,387||0.62 (0.44–0.87)|
|Baylin A, 2006 |
|Costa Rica, case-crossover design||Habitual coffee consumption||Nonfatal MI, 1 h after coffee drinking|
|≤1 cup/day||9/66||4.14 (2.03–8.42)||Coffee intake probably set off MI|
|2–3 cups/day||44/280||1.60 (1.16–2.21)|
|≥4 cups/day||27/120||1.06 (0.69–1.63)|
|Cornelis MC, 2006 |
|Slow caffeine metabolizer||Coffe intake ≥4 cups/day vs <1 cup/day||First acute nonfatal MI||2014/2014||1.64 (1.14–2.34)||Increased MI risk only in subjects with impaired caffeine metabolism|
|Rapid caffeine metabolizer population-based case-control study||Coffe intake ≥4 cups/day vs <1 cup/day||First acute nonfatal MI||2014/2014||0.99 (0.66–1.48)|
|Silletta MG, 2007 |
Coffee consumption and risk of cardiovascular events after acute myocardial infarction: results from the GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico)-Prevenzione trial.
Circulation. 2007; 116: 2944-2951
|GISSI-Prevenzione trial, prospective study||Coffee consumption >4 cups/day vs none||CVD events (CV death, nonfatal MI, nonfatal stroke in post-MI patients||1167/11,213||0.88 (0.64–1.20)||Moderate coffee intake is not associated with CV events post-MI|
|Larsson LC, 2008 |
|Alpha-Tocopherol, Beta-Carotene||Coffee consumption ≥8 cups/day vs <2 cups/day||Stroke subtypes|
|Cancer Prevention Study, prospective study||Cerebral infarction||2702/26,556; Men||0.77 (0.66–0.90)||High coffee consumption lowers cerebral infarction risk|
|Intracerebral hemorrhages||383/26,556; Men||0.98 (0.66–1.47)|
|Subarachnoid hemorrhages||196/26,556; Men||1.18 (0.63–2.20)|
|Lopez-Garcia E, 2008 |
|Health Professionals Follow-up Study and Nurses' Health Study, prospective cohort study||Coffee consumption ≥6 cups/day vs <1 cup/month||CVD mortality||2049/41,736; Men||0.56 (0.31–1.03)|
|Coffee consumption ≥6 cups/day vs <1 cup/month||CVD mortality||2368/86,214; Women||0.81 (0.61–1.06)|
|Coffee consumption ≥6 cups/day vs <1 cup/month||Cancer mortality||2491/41,736; Men||1.14 (0.79–1.65)|
|Coffee consumption ≥6 cups/day vs <1 cup/month||Cancer mortality||5011/86,214; Women||1.05 (0.87–1.28)|
|Coffee consumption ≥6 cups/day vs <1 cup/month||Other causes||2348/41,736; Men||0.65 (0.11–1.04)|
|Coffee consumption ≥6 cups/day vs <1 cup/month||Other causes||3716/86,214; Women||0.60 (0.46–0.77)|
|In both men and women the reduced CVD deaths mainly explains the modest inverse association between coffee consumption and all cause mortality|
|Coffee consumption ≥6 cups/day vs <1cup/month||All causes||6888/41,736; Men||0.80 (0.62–1.04)|
|Coffee consumption ≥6 cups/day vs <1cup/month||All causes||11,095/86,214; Women||0.83 (0.73–0.95)|
|Decaffeinated coffee consumption ≥4 cups/day vs <1cup/month||CVD mortality||2049/41,736; Men||0.83 (0.52–1.31)|
|Decaffeinated coffee consumption ≥4 cups/day vs <1cup/month||CVD mortality||2368/86,214; Women||0.55 (0.30–1.04)|
|Decaffeinated coffee consumption ≥4 cups/day vs <1cup/month||Cancer mortality||2491/41,736; Men||1.20 (0.87–1.66)|
|Decaffeinated coffee consumption ≥4 cups/day vs <1cup/month||Cancer mortality||5011/86,214; Women||0.86 (0.60–1.23)|
|Decaffeinated coffee consumption ≥4 cups/day vs <1cup/month||All causes||6888/41,736; Men||0.81 (0.64–1.03)|
|Decaffeinated coffee consumption ≥4 cups/day vs <1cup/month||All causes||11,095/86,214; Women||0.78 (0.61–1.00)|
|Wu JN, 2009 |
|21 prospective cohort studies, meta-analysis||Coffee consumption <1 cup/day (US) or ≤2 cups/day(Europe) vs ≥6 or ≥7 cups/day||CHD||15,599/407,806; pooled||1.07 (0.87–1.32)||No long-term increased CHD risk|
|Moderate coffee consumption||CHD||Women||0.82 (0.73–0.92)||Lower CHD risk in moderate coffee drinker women|
|de Koning Gans JM, 2010 |
|Prospective study||Coffee consumption>6 cups/day vs <1 cup/day||CHD morbidity||1387/37,514||0.91 (0.74–1.11)||U shaped association between coffee consumption and lower CHD morbidity|
|Coffee consumption>6 cups/day vs <1 cup/day||Stroke morbidity||563/37,514||1.22 (0.88–1.70)|
|Coffee consumption>6 cups/day vs <1 cup/day||CHD mortality||123||0.73 (0.37–1.42)||Non significant slight reduction in CHD mortality according to moderate coffee consumption|
|Coffee consumption>6 cups/day vs <1 cup/day||Stroke mortality||70||1.34 (0.49–3.64)|
|Coffee consumption>6 cups/day vs <1 cup/day||All causes mortality||1405||0.93 (0.76–1.15)||No effect of coffee on stroke or all causes mortality|
|Mostofsky E, 2010 |
|Stroke onset study, multicenter case-crossover study||Coffee drinkers vs non drinkers||Stroke onset in subjects with acute ischemic stroke|
|1 h after 1 serving of coffee||35/390||2.0 (1.4–2.8)||Infrequent coffee drinkers have increased ischemic stroke risk onset|
|1 h after 1 serving of caffeinated coffee in subjects drinking ≤1 cup/day||–||↑RR (values not available)|
3.1 Coffe and cardiovascular risk factors: negative aspects
3.2 Coffe and cardiovascular risk factors: positive aspects
3.3 Evidence from epidemiology
- Silletta M.G.
- Marfisi R.
- Levantesi G.
- Boccanelli A.
- Chieffo C.
- Franzosi M.
- et al.
- Silletta M.G.
- Marfisi R.
- Levantesi G.
- Boccanelli A.
- Chieffo C.
- Franzosi M.
- et al.
- Silletta M.G.
- Marfisi R.
- Levantesi G.
- Boccanelli A.
- Chieffo C.
- Franzosi M.
- et al.
4.1 Evidence from epidemiology: coronary artery disease
|Tea, Reference||Study||Exposure||Endpoint||N. cases/N. total||Adjusted RR or OR (95% CI)||Summary|
|Woodward M, 1999 |
|Scottish Heart Health Study, cohort study||Tea consumption||CHD||?/5724; Men||1.10 (0.51–2.37)||Tendency to increased risk|
|CHD||?/5843; Women||1.06 (0.28–4.05)|
|Peters U, 2001 |
|10 cohort studies and 7 case-control studies, meta-analysis||Tea consumption 3 cups/day vs none||Stroke, MI and all CHD||Stroke and CHD too heterogeneous|
|MI||–||0.89 (0.70–1.01)||Incidence rate of MI decreased by 11% with an increase in tea consumption of 3 cups/day|
|Geleijnse JM, 2002 |
|The Rotterdam Study, population-based study||Tea drinkers >375 mL/day vs nontea drinkers||Fatal and nonfatal MI|
|Incident Mi||146/4807||0.57 (0.33–0.98)||Strong reduction of fatal MI according to high green tea consumption|
|Nonfatal MI||116/4807||0.68 (0.37–1.26)|
|Fatal MI||30/4807||0.30 (0.09–0.94)|
|Andersen LF, 2006 |
|Iowa Women's Health Study, prospective study, postmenopausal||Tea >3 cups/day vs none||Death due to CVD||1411/41,836||0.99 (0.86–1.14)||Tea no associations|
|Tea >3 cups/day vs none||Total mortality||4265/41,836||1.03 (0.95–1.12)|
|Kuriyama S, 2006 |
|The Ohsaki National Health Insurance Cohort Study, population based prospective study||Green tea consumption 3–4 cups/day vs <1 cup/day||CVD, cancer and all causes mortality|
|CVD mortality||481/40,530; Men||0.87 (0.64–1.19)|
|All cause mortality||2668/40,530; Men||0.88 (0.78–1.00)||Green tea consumption lowers all causes and CVD mortality|
|CVD mortality||411/40,530; Women||0.61 (0.44–0.85)|
|All cause mortality||1541/40,530; Women||0.80 (0.68–0.94)|
|Larsson LC, 2008 |
|Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, prospective study||Tea consumption ≥8cups/day vs <2 cups/day||Cerebral infarction||2702/26,556; Men||0.79 (0.68–0.92)||High tea consumption reduces Cerebral infarction risk|
|Intracerebral hemorrhages||383/26,556; Men||1.10 (0.77–1.58)|
|Subarachnoid hemorrhages||196/26,556; Men||0.76 (0.42–1.37)|
|Arab L, 2009 |
|Meta–analysis||Green or black tea consumption ≥3 cups/day vs <1 cup/day||Fatal or nonfatal stroke||4378/194,965; pooled||0.79 (0.73–0.85)||≥3 cups/day of green or black reduce fatal and nonfatal stroke|
|Mostofsky E, 2010 |
|Stroke onset study, multicenter case-crossover study||1 h after 1 serving of caffeinated tea||Stroke onset in subjects with acute ischemic stroke||0.9 (0.4–2.0)|
|de Koning Gans JM, 2010 |
|Prospective study||Tea consumption>6 cups/day vs <1 cup/day||CHD morbidity||1387/37,514||0.64 (0.46–0.90)||Tea consumption is linearly associated with lower CHD morbidity|
|Tea consumption>6 cups/day vs <1 cup/day||Stroke morbidity||563/37,514||1.24 (0.82–1.89)|
|Tea consumption>6 cups/day vs <1 cup/day||CHD mortality||123||0.93 (0.39–2.25)||3 to 6 cups of tea/day reduce CHD risk mortality|
|Tea consumption>6 cups/day vs <1 cup/day||Stroke mortality||70||1.16 (0.38–3.56)||No effect of tea on both stroke or all causes mortality|
|Tea consumption>6 cups/day vs <1 cup/day||All causes mortality||1405||1.13 (0.87–1.48)|
4.2 Evidence from epidemiology: cerebrovascular disease
4.3 Tea and cardiovascular risk factors
- Vogel J.H.K.
- Bolling S.F.
- Costello R.B.
- Guarneri E.M.
- Krucoff M.W.
- Longhurst J.C.
- et al.
Conflict of interest statement
- •Daily intake of a anti-thrombotic diet may offer a suitable and effective way of coronary artery disease prevention.
- •A large amount of experimental and epidemiological studies clearly indicated a beneficial effect of polyphenols in preventing coronary artery disease.
- •Chocolate, coffee and tea are important dietary sources of polyphenols.
- •The blood pressure lowering effects and the anti-inflammatory activity of dark chocolate suggests its use as potential prophylactic and therapeutic agent.
- •Regular consumption of moderate quantities of coffee and (green) tea seems to be associated with a small protection against coronary artery disease.
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