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Take a look at a selection of our recent media coverage:

Should daily coffee intake be part of a healthy diet?

11th April 2022

Studies have shown that daily coffee intake is associated with cardiovascular benefits such as a lower risk of developing CVD and arrhythmias

Coffee intake (whether ground or instant) of at least 2 – 3 cups per day has been found to be associated with significant reductions in the risk of developing cardiovascular disease (CVD), arrhythmias, as well as cardiovascular and all-cause mortality. This is according to the findings of three studies analysing data held within the UK Biobank.

Although coffee contains caffeine, it is also a rich source of phenolic compounds including chlorogenic acids which contribute to coffee’s antioxidant activity. Moreover, coffee intake at midlife has been associated with a lower risk of dementia and Alzheimer’s disease compared with those drinking no or only little coffee. However, the cardiovascular benefits from drinking coffee are less clear with one study finding that in men, the risk of nonfatal myocardial infarction was not associated with coffee drinking. In contrast, a large prospective study observed that coffee consumption was inversely associated with total and cause-specific mortality.

Due to these conflicting results, three studies presented at the American College of Cardiology Scientific Session have examined cardiovascular and mortality benefits disease associated with coffee intake.

In the first study, effects of habitual coffee consumption on incident cardiovascular disease, arrhythmia, and mortality: findings from UK BIOBANK, researchers from the University of Melbourne, Australia, included data from 382,535 individuals with a mean age of 57 years (52% female) and assessed the effect of coffee intake over a 10-year period. The results showed that a coffee intake of 2 – 3 cups/day was significantly associated (for all associations, p < 0.01) with the lowest risk for developing CVD (Hazard ratio, HR = 0.91, 95% CI 0.88 – 0.94), coronary heart disease (HR = 0.90), heart failure (HR = 0.85) and all-cause mortality (HR = 0.86). They found a U-shaped relationship between higher coffee intake and incident arrhythmia which was also lowest at 2 – 3 cups/day (HR = 0.92).

In the second study, regular coffee intake is associated with improved mortality in prevalent cardiovascular disease, the Australian team focused on the effect of coffee in patients with existing cardiovascular disease. With a population of 502,543 individuals, again followed for 10 years, CVD was subsequently diagnosed in 342,279 participants, of whom, 19.6% died. The team found that coffee intake was safe at all levels and that survival was improved again at 2 – 3 cups/day (HR = 0.92, 95% CI 0.86 – 0.99, p = 0.03). Among 24,111 participants diagnosed with an arrhythmia, drinking only one cup of coffee per day was associated with the lowest mortality risk (HR = 0.85) and specifically in those with atrial fibrillation or flutter, one cup of coffee per day was associated with improved survival (HR = 0.82, p < 0.01).

In the third study, ground, instant or decaffeinated coffee? Impact of different coffee subtypes on incident arrhythmia, cardiovascular disease and mortality, the team wondered if there were any differential cardiovascular benefits depending on how the coffee was prepared. Overall, they found that drinking between 1 and 5 cups of coffee per day were associated with a reduced risk of arrhythmia, CVD, CHD, heart failure and stroke. The greatest reduction in risk for CVD was seen with drinking 2 – 3 cups/day of ground coffee (HR = 0.83, 95% CI 0.79 – 0.87) but there was still a significant, albeit smaller, reduction in risk from consuming instant coffee (HR = 0.91, 95% CI 0.88 – 0.95).

Finally, in the third study, the authors showed that drinking 2 – 3 cups/day of decaffeinated coffee was associated with a mortality benefit (HR = 0.85, 95% CI 0.80 – 0.91, p < 0.01), leading the authors to conclude that non-caffeine compounds within coffee are likely to be important factors associated with greater survival among coffee drinkers.

Given these findings, the authors suggested that coffee intake should be considered as part of a healthy diet.

Prospective analysis shows regular meat eaters at higher risk of several types of cancer

21st March 2022

A UK study has found that meat eaters have an increased risk of developing cancer compared with either low meat eaters, pescatarians or vegetarians

Individuals who are regular meat eaters have been found to be at a higher risk of all and some specific cancers compared to those who are either low meat eaters, pescatarians or vegetarians. This was the finding of a study of the UK Biobank database by researchers from the Cancer Epidemiology Unit, University of Oxford, Oxford, UK.

Cancer has been declared by the World Health Organization (WHO) as a leading cause of death worldwide accounting for nearly one in six of all deaths (10 million in 2020). Moreover, according to WHO, breast, lung, colorectal and prostate cancers are the most common forms of the disease. Understanding the causal relationship between dietary patterns or even particular dietary components and cancer aetiology and prevention is a challenge. For example, undertaking randomised controlled intervention trials to examine the association between diet and cancer outcomes are not feasible, for a number of reasons including cost, the difficulty of ensuring compliance among control and intervention groups as well as the long time-frame and exposure necessary to affect the carcinogenesis process. Although it has been shown that the risk of some cancers is lower in fish eaters and vegetarians than in meat eaters, it is not universally true with other work showing no statistically significant associations with dietary pattern and risk of premenopausal breast cancer.

For the present analysis, the Oxford team examined the relationship between those who ate meat at least 5 times a week, low meat consumers (< 5 times/week), pescatarians and vegetarians and the risk of all cancers and in particular, colorectal, postmenopausal breast and prostate cancers. They used data held in the UK Biobank and excluded individuals with a cancer diagnosis at recruitment. Participants completed an online questionnaire at recruitment into the database which asked about consumption and frequency of meat intake. The team also assessed whether specific hormones such as insulin-like growth factor-1 and testosterone as well as body mass index, might have potential mediator effects on the association between dietary patterns and cancer risk. The risks for the development of all and any of the specific cancers, were assessed using meat eaters as the reference group.

Meat eaters and cancer risk

A total of 247,571 individuals with a mean age of 56 years (46.4% female) were classed as meat eaters, 205,385 as low-meat eaters, 10,696 as pescatarians and 8,685 as vegetarians. After an average follow-up of 11.4 years, 54,861 incidence cases of cancer occurred; 5882 colorectal, 7537 women with postmenopausal breast cancer, 9501 men with prostate cancer.

After adjustment for several factors such as smoking status, physical activity etc, a vegetarian diet was associated with a 14% lower risk of all cancers compared to the reference group. (hazard ratio, HR = 0.86, 95% CI 0.80 – 0.93). This risk was also significantly reduced for breast cancer (HR = 0.82) and prostate cancer (HR = 0.69).

For pescatarians, there was also a lower risk of all cancers (HR = 0.90) compared to the reference meat group and for prostate cancer (HR = 0.80). For those categorised as low-meat eaters, the risks were only significantly lower for colorectal cancer (HR = 0.91).

After adjustment for possible mediators, only body mass index was found to be relevant and the risk of all cancers was slightly attenuated for vegetarians (HR = 0.88) and pescatarians (HR = 0.92) but remained significant. Furthermore, the reduced cancer risk remained significant among pescatarians and vegetarians but only for prostate cancer.

The authors concluded that being a pescatarian or vegetarian was associated with a lower risk of all cancers and that this might be attributable to differences in dietary factors in comparison to those who regularly eat meat. However, they added that it was unclear if these associations are causal or due to residual confounding, i.e., due to other, but unmeasured factors.

Citation
Watling CZ et al. Risk of cancer in regular and low meat-eaters, fish-eaters, and vegetarians: a prospective analysis of UK Biobank participants BMC Med 2022

Higher intake of raw but not cooked vegetables linked to lower CVD risk

1st March 2022

A higher intake of raw but not cooked vegetables appears to be associated with a lower incidence of cardiovascular disease

A higher intake of raw rather than cooked vegetables appears to be linked with a lower incidence of cardiovascular disease (CVD) although this difference might be due to residual confounding. This was the conclusion of a study of patients in the UK Biobank by researchers from the Nuffield Department of Population Health, University of Oxford, Oxford, UK.

The potential health benefits associated with an increased intake of fruit and vegetables has been widely reported for many years. In a 2019 systematic review of studies, the authors noted that the strongest (probable) evidence for increased vegetable intake was for cardiovascular disease protection although there was possible evidence for a reduced risk of colon cancer, depression and pancreatic diseases for fruit intake. These findings were echoed in a 2020 review which reported that current evidence suggests that fruit and vegetable have the strongest effects in relation to prevention of CVDs. Moreover, another study has found that in 2017, 11 million deaths were attributable to dietary risk factors, including 2 million due to a low intake of fruits. In the relation to vegetables, there is little data on the relative benefits of eating either raw (e.g., in salads) or cooked vegetables.

For the present study, the Oxford team used the UK Biobank database to examine the effect of vegetable intake and specifically, the independent effect of raw and cooked vegetables. Within the database, information was collected on the total daily intake of both both uncooked and cooked vegetables. Participants were asked ‘on average how many heaped tablespoons of salad or raw vegetables would you eat per day‘? and the same question but asking specifically about cooked vegetables. The quantities were then categorised as 0, 1 – 2, 3 – 4, and > 5 for raw/cooked vegetables and 0 – 1, 2 – 3, 4 – 7 and > 8 for total vegetable intake. The researcher also collected demographic, co-morbidity and lifestyle factors such as smoking status, amounts of physical exercise etc which were adjusted for in regression models. The primary outcomes were CVD incidence and mortality with secondary outcomes of myocardial infarction, incident stroke and all-cause mortality.

Higher intake of vegetables and CVD risk

A total of 399,586 participants with a mean age of 56.1 years (55.4% female) were included in the analysis and during a median follow-up of 12.1 years, there were 18,052 cases of CVD.

Compared to those consuming the lowest total vegetable intake, participating consuming the highest intake had a 10% lower incidence of CVD (hazard ratio, HR = 0.90, 95% CI 0.83 – 0.97). When separating raw and cooked vegetables, the results were also significant, e.g., for raw vegetables the HR was 0.79 and 0.77 for cooked vegetables.

However, when the models were adjusted for covariates, much of the benefits from raw vegetable intake on CVD incidence were attenuated (HR changing from 0.79 to 0.89) although the result remained significant. In contrast, the association with cooked vegetables was completely attenuated (HR = 1.0, 95% CI 0.91 – 1.09).

Based on these findings, the authors concluded that a higher intake of raw but not cooked vegetables was associated with a lower risk of CVD. Nevertheless, they added a caveat that residual confounding was a likely explanation for much, if not all of the observed associations. In other words, it was possible that there were other, unaccounted for variables, not adjusted for in their models, which might have been important. As such, this means that the results of the study can only demonstrate an association, rather than a causal relationship between intake of raw and cooked vegetables and the risk of incident CVD.

Citation
Feng Q et al. Raw and Cooked Vegetable Consumption and Risk of Cardiovascular Disease: a Study of 400,000 Adults in UK Biobank Front Nutr 2022

Alcoholic spirit intake associated with increased risk of ventricular arrhythmias

23rd December 2021

Only increased alcoholic spirit intake has been found to be associated with a higher risk of ventricular arrhythmias among regular drinkers

Increased alcoholic spirit intake is associated with an increased risk of ventricular arrhythmia but this elevated risk is absent for other forms of alcoholic beverages. This was a key finding from a retrospective analysis by a team from the Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Australia.

Higher intakes of alcohol are generally considered to damage the cardiovascular system although light to moderate alcohol intake appears to be protective. The term ‘holiday heart syndrome‘ has been coined to describe any alcohol-induced atrial arrhythmias and/or conduction disturbance associated with heavy consumption in a person without other clinical evidence of heart disease. Whilst the relationship between atrial arrhythmias and alcohol has become well recognised, there is a paucity of data linking alcohol intake with ventricular arrhythmias (VA). In fact, the available evidence is inconsistent, with some data showing a non-significant association whereas other studies suggesting that heavy alcohol consumption is an important contributing factor. Moreover, the influence of the type of alcoholic drink on VA or even sudden cardiac death (SCD) is also uncertain.

For the present study, researchers used information held in the UK Biobank which provides data on approximately half a million community-dwelling individuals aged 40 to 69 years across the UK. For their analysis, the researchers focused on incident cases of VA but excluded those with a previous history of the condition and former drinkers. The amount of alcohol intake was reported in terms of a standard drink, defined as 8g of alcohol and the average number of standard drinks consumed per week. For alcohol intake, the team also considered the type of each beverage consumed and created regression models which adjusted for several covariates such as age, sex, race, education.

Findings

Data for a total of 408,712 individuals with an average age of 58.3 years (52.1% female) were included in the analysis and who were followed up for a median duration of 11.5 years. The median alcohol intake for the whole cohort was 8 drinks per week although 5.5% of the group reported having never consumed alcohol.

There were a total of 1733 incident VA events and 2044 SCDs which occurred during the follow-up period. Overall, there was no statistically significant association between total alcohol intake and the risk of VA. However, when considered by type of alcoholic beverage, only alcoholic spirit intake was linearly linked with an increased risk of VA among those consuming greater than 14 drinks per week (hazard ratio, HR = 1.15, 95% CI 0.98 – 1.34) and this became statistically significant with more than 28 drinks per week (HR = 1.33, 95% CI 1.03 – 1.73).

For SCD there was a U-shaped distribution of risk with the lowest risk at around 7 drinks per week.

The authors concluded that they were unable to find an association between total intake of beer, cider and wine and VA and that only increased alcoholic spirit intake was linked to a higher risk. In fact, wine intake was associated with a lower risk of SCD although the authors suggested that these findings require clarification from experimental studies.

Citation

Tu SJ et al. Alcohol consumption and risk of ventricular arrhythmias and sudden cardiac death: An observational study of 408,712 individuals Heart rhythm 2021