Can You Prevent Atrial Fibrillation by Giving Up Coffee?


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"I recently met with a patient we’ll call Pete. Pete told me he was diagnosed with atrial fibrillation for the first time after going to the emergency room for heart palpitations and shortness of breath. After the scare, he decided to give up coffee. But a new review on diet and atrial fibrillation shows that might not be his best next step.

Can You Prevent Atrial Fibrillation by Giving Up Coffee?

Atrial fibrillation is a fast, irregular heart rhythm that begins in the upper chambers of the heart. It often causes the symptoms that Pete had, but it can also cause dizziness, chest pain, arm pain, anxiety, swelling in the legs and stomach, and the inability to exercise.

Pete was treated in the emergency room with a procedure called cardioversion. Electrical pads were placed on his chest when he was sedated, then an electrical shock was delivered. The shocks don’t hurt the heart muscle, but cause all electricity in the heart to be released at once. This helps stop abnormal chaotic rhythms like atrial fibrillation, and assists areas within the heart that typically maintain its pace to take over.

Serious Lifestyle Changes After a Trip to the ER
I saw Pete a few weeks after his ER visit. He’d experienced heart palpitations before, but they’d been shorter and stopped on their own. His recent episode had lasted four to five hours, and when he became short of breath, he decided to go to the emergency room. He told me that this was a wake-up call, and that he was going to make some serious lifestyle changes.

The first thing he mentioned is something I hear very often: “I’ve given up coffee completely, even though I didn’t want to.” His additional changes included trying to lose weight, get more exercise, stress less, and eat a better diet. But did he really have to give up coffee?

Coffee and Energy Drinks: Not All Caffeinated Products Are the Same
It makes sense that coffee may cause heart problems. Coffee contains caffeine, a heart stimulant that can elevate heart rate and cause palpitations. Atrial fibrillation is a fast, abnormal heart rhythm that can also cause palpitations. When you put the two facts together, cutting coffee out of your diet seems like a reasonable lifestyle change to prevent future electrical problems in your heart.

In my experience, people typically group all caffeinated products together when they talk about lifestyle changes. I want to consider coffee alone. Energy drinks are their own distinct product, and as such can convey unique risks different from coffee, tea, or sodas. These drinks often contain very high levels of caffeine in addition to one or more heart stimulants, and the multiple stimulants can be a dangerous mix for people who are vulnerable to abnormal heart rhythms.

I’ve seen young people die from cardiac arrest who consumed multiple energy drinks and then exercised, but I’ve never seen such events in people who drink coffee.

Coffee and Heart Disease Risk
Like energy drinks, coffee can raise your heart rate and blood pressure — typically when you first start drinking it, or when you increase the amount you’re drinking. Despite these changes, no large long-term studies have shown heart disease risk associated with coffee use.

In fact, an analysis of 36 studies including 1,279,804 patients that was published in February 2014 in Circulation showed that drinking up to five cups of coffee a day protected people from heart disease, including stroke, heart failure, and cardiac death. But this study didn’t look at risk of abnormal heart rhythms. Specifically, this study did not address drinking coffee and the risk for atrial fibrillation, which is not only the most common abnormal heart rhythm, but also a frequent cause of disabling strokes.

Coffee and Atrial Fibrillation Risk
In the June 2016 issue of the European Journal of Preventative Cardiology, researchers published a large study asking this specific question: Does drinking coffee increase risk for atrial fibrillation?

The study included 57,053 people from Denmark who completed a survey about the foods they ate and were then followed, on average, for 13.5 years. Study participants were between ages 50 and 64; we see atrial fibrillation in 2 to 5 percent of this age group. Approximately 25 percent of the people studied had high blood pressure, and nearly 50 percent had elevated cholesterol. The study population was compared by their average intake of coffee in cups per day: none, less than 1 cup, 1 cup, 2 to 3 cups, 4 to 5 cups, 6 to 7 cups, or more than 7 cups. Coffee drinkers were compared with people who didn’t drink coffee to determine the incidence of the abnormal heart rhythm.

The number of people per 100 who developed atrial fibrillation (incidence) in each group was:

Less than 1 cup per day: 0.88
1 cup per day: 0.86
2 to 3 cups per day: 0.84
4 to 5 cups per day: 0.79
6 to 7 cups per day: 0.79
More than 7 cups/day: 0.79
A significant and interesting trend was that the more coffee people drank each day, the lower their risk of developing atrial fibrillation.

When we think about coffee and its effects, caffeine is the component that often first comes to mind. In Denmark, the vast majority of coffee drinkers have caffeinated rather than decaf, so this study looked at the caffeinated variety. But coffee is much more than caffeine: It contains many other compounds that may be healthy. In fact, coffee contains more than 1,000 compounds, and some of these have antioxidant and anti-inflammatory properties that may be heart healthy.

Balancing Coffee Benefits and Risks
Coffee is not without risk: It can cause stomach and esophageal irritation and injury, loss of electrolytes such as calcium and magnesium in your body, and bone loss. Coffee can also impact the quality and length of your sleep. And as many people are aware, caffeine can be addictive, impacting the quality of life for some people. As with other aspects of lifestyle I’ve discussed in my other columns, a moderate approach to drinking coffee is always a good rule to follow.

But let’s return now to Pete. I told him, “I agree that you should improve your exercise, work on weight loss, and eat a diet heavily based on fruits, vegetables, and nuts. But I have no data to suggest that you should stop drinking coffee to lower your risk of atrial fibrillation. In fact, if your use was moderate, then drinking coffee may actually lower your risk.”"

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