Annette A.A. Bak

The Effect on Serum Cholesterol Levels of Coffee Brewed by Filtering or Boiling

Previous reports have indicated that coffee consumption may increase serum cholesterol levels. We studied the effects of coffee prepared by two common brewing methods (filtering and boiling) on serum lipid levels in a 12-week randomized trial involving 107 young adult subjects with normal serum cholesterol levels. After a three-week run-in period during which they all consumed filtered coffee, the participants were randomly assigned to one of three groups receiving four to six cups of boiled coffee a day, four to six cups of filtered coffee a day, or no coffee, for a period of nine weeks. As compared with the change from base line in the filtered-coffee group, the serum total cholesterol level increased after the consumption of boiled coffee by 0.48 mmol per liter (95 percent confidence limits, 0.13 and 0.83), and the low-density lipoprotein cholesterol level increased by 0.39 mmol per liter (95 percent confidence limits, -0.04 and 0.82). There was no significant difference in the change in serum total or low-density lipoprotein cholesterol levels between the filtered-coffee group and the group that drank no coffee. The levels of high-density lipoprotein cholesterol and apolipoproteins were not affected by boiled or filtered coffee. We conclude that drinking filtered coffee does not affect serum lipid levels. The consumption of boiled coffee, however, has an effect on serum cholesterol levels amounting to a mean net increase of 10 percent of the base-line level after nine weeks.

Low serum cholesterol concentration and serotonin metabolism in men.

1. 1.1. Lindberg G, 2. Rastam L, 3. Gullberg B, 4. Eklund GA . Low serum cholesterol concentration and short term mortality from injuries in men and women. BMJ 1992;305:277–9. 2. 2.1. Brown SL, 2. Dalive ME, 3. Harris TB, 4. Simonsick EM

Higher Prevalence of Depressive Symptoms in Middle-Aged Men With Low Serum Cholesterol Levels

Objective: Investigators from several studies have reported a positive relationship between low cholesterol levels and death due to violent causes (eg, suicide and accidents), possibly mediated by depressive symptoms, aggression or hostility, or impulsivity. We set out to establish whether middle-aged men with chronically low cholesterol levels (≤4.5 mmol/liter) have a higher risk of having depressive symptoms, according to scores on the Beck Depression Inventory, compared with a reference group of men with cholesterol levels between 6 and 7 mmol/liter. A similar comparison was also made for measures of anger, hostility, and impulsivity. Methods: Cholesterol measurements were obtained as part of a population-based cholesterol screening study in 1990–1991. These levels were remeasured in 1993–1994. Only those whose cholesterol level remained in the same range were included in the study. Depressive symptoms were assessed by using the Beck Depression Inventory; anger, by questionnaires based on the Spielberger Anger Expression Scale and State-Trait Anger Scale; hostility, by the Buss-Durkee Hostility Inventory; and impulsivity, by the Eysenck and Eysenck Impulsivity Questionnaire. Results: Men with chronically low cholesterol levels showed a consistently higher risk of having depressive symptoms (Beck Depression Inventory score ≥15 or ≥17) than the reference group, even after adjusting for age, energy intake, alcohol use, and presence of chronic diseases. No differences in anger, hostility, and impulsivity were observed between the two groups. Conclusions: Men with a lower cholesterol level (≤4.5 mmol/liter) have a higher prevalence of depressive symptoms than those with a cholesterol level between 6 and 7 mmol/liter. These data may be important in the ongoing debate on the putative association between low cholesterol levels and violent death.

Arterial stiffness in postmenopausal women: determinants of pulse wave velocity.

Objective To investigate the degree and potential cardiovascular determinants of arterial stiffness, assessed by aortic pulse wave velocity (PWV) measurements, and to relate arterial stiffness to absolute 10–12-year risks of stroke, coronary heart disease and death, as estimated by available risk functions, in postmenopausal women. Method We performed a cross-sectional study among 385 postmenopausal women, aged 50–74 years, sampled from the general population. Arterial stiffness was assessed non-invasively by measurement of aortic PWV using applanation tonometry. Information on health was obtained by medical history, registration of current medication, and physical examination. Height, weight, waist and hip circumferences, fasting glucose, total and high-density lipoprotein (HDL) cholesterol, triglycerides, resting blood pressure, and heart rate were measured. Three risk scores were used to estimate, for each individual, the absolute risk of stroke, coronary heart disease, and death within 10–12 years as a function of their cardiovascular risk factor profile. The relationship between PWV and these risk scores was subsequently determined. Results Significant positive relationships with PWV were found for body mass index, fasting glucose, diabetes mellitus, and triglycerides in analyses adjusted for age, mean arterial blood pressure, and heart rate. Height and HDL cholesterol were inversely related to PWV. The risks of stroke, coronary heart disease, and death increased with increasing PWV in a linear graded manner. Conclusions This cross-sectional study among postmenopausal women provides evidence that most of the established cardiovascular risk factors are determinants of aortic PWV. Increased PWV marks an increased risk of stroke, coronary heart disease, and death within 10–12 years.

Effects of nitrendipine and enalapril on left ventricular mass in patients with non-insulin-dependent diabetes mellitus and hypertension

Objective To compare the effects of a calcium antagonist (nitrendipine) and an angiotensin converting enzyme inhibitor (enalapril) with those of placebo on left ventricular mass in patients with non-insulin-dependent diabetes mellitus and hypertension. Design A double-blind randomized, placebo-controlled trial. Setting General practitioners referred patients to the trial physician. Patients The study population comprised 121 patients with non-insulin-dependent diabetes mellitus. Inclusion criteria for blood pressure were diastolic blood pressure 90–115 mmHg and systolic blood pressure ⩽ 200 mmHg, while subjects were not being administered blood-pressure-lowering drugs for 3 weeks. Intervention Patients were randomly allocated to receive nitrendipine (n = 40), enalapril (n = 40) or placebo (n = 41). The treatment period was 48 weeks. Main outcome measures The effect of nitrendipine was defined as the difference in change in left ventricular mass index from baseline between nitrendipine treatment and placebo after 48 weeks of treatment. The effects of nitrendipine compared with that of enalapril and of enalapril compared with placebo were defined similarly. Left ventricular mass was measured by M-mode echocardiography. Results Use of nitrendipine and enalapril led to significant and almost identical reductions in systolic and diastolic blood pressures. During 48 weeks left ventricular mass index decreased by 5% for patients in the nitrendipine group (decrease by 12 g/m2, 95% confidence interval 1–23), remained about the same for patients in the enalapril group (decrease by 1 g/m2, 95% confidence interval decrease by 10 to increase by 9) and increased by 9% for patients in the placebo group (increase by 9 g/m2, 95% confidence interval 2–16). Conclusion These results indicate that administration of nitrendipine to patients with non-insulin-dependent diabetes mellitus and hypertension reduces left ventricular mass index. Enalapril appears not to induce regression, but perhaps prevents progression with an effect that is intermediate between those of nitrendipine and placebo. J Hypertens 16:689–696

The effect of hormone replacement therapy on serum homocysteine levels in perimenopausal women: a randomized controlled trial

Serum homocysteine levels may be lowered by hormone replacement therapy, but randomized controlled trial data are scarce. We performed a single center randomized placebo-controlled trial to assess the 6 months effect of hormone replacement therapy compared with placebo on fasting serum homocysteine levels in 121 perimenopausal women free of cardiovascular disease, and recruited from the general population. The trial was double-blind with respect to a sequential combined regimen of oral 17 beta-estradiol and desogestrel (17 beta E(2)-D) and the placebo group and open with respect to a combination of conjugated equine estrogens and norgestrel (CEE-N). At baseline and after 6 months, fasting serum homocysteine levels were measured. Differences in 6 months serum homocysteine levels from baseline between treatment and placebo groups were calculated, and expressed as a percentage of the 6 months placebo level. After 6 months, the difference in serum homocysteine levels between women receiving 17 beta E(2)-D and placebo was -6.3% (95% CI, -12.4%; 0.0%, P=0.06). The difference between women receiving CEE-N and placebo was -10.1% (95% CI, -16.7%; -2.9%, P<0.01). The difference between the combined group of both types of hormone replacement therapy users and placebo was -7.8% (95% CI, -13.2%; -2.0%, P=0.01). No significant difference was observed between the two active regimens. Our results indicate that hormone replacement therapy decreases homocysteine levels in perimenopausal women.

Coffee, caffeine and hemostasis: results from two randomized studies

The influence of coffee and caffeine consumption on hemostatic factors was studied in 2 randomized trials. Both studies were conducted in young, healthy adults. In the first study, 107 participants were randomly allocated to one or 3 intervention groups, drinking filtered coffee, boiled coffee or no coffee at all, respectively, for a period of 9 weeks. In the second study, 69 subjects received either 4-6 tablets containing 75 mg caffeine or the same amount of placebo tablets, while using decaffeinated coffee. In this double-blind study caffeine intake from any other source was not allowed. Blood samples for hemostatic factors were obtained at baseline and after 9 weeks of intervention. The findings indicate no effect of coffee consumption on fibrinogen, clotting factor VII activity, factor VIII antigen, protein C and protein S and also no effect of caffeine consumption on fibrinogen and factor VII activity.

Does the beneficial effect of HRT on endothelial function depend on lipid changes

OBJECTIVES To determine whether improvement in endothelial function of the brachial artery observed in women treated with hormone replacement therapy (HRT) may be explained by changes in lipid profile or blood pressure, information was used obtained in a single-centre, randomised, double blind, placebo-controlled trial. METHODS Hundred-and-five healthy postmenopausal women, aged 50-65 years, were treated with 0.625 mg conjugated equine estrogens (CEE) combined with 2.5 mg medroxyprogesterone acetate (MPA) (CEE+MPA), 2.5 mg tibolone or placebo for 3 months. At baseline and after 3 months, endothelial function was assessed using flow-mediated dilatation (FMD) and nitro glycerine-mediated dilatation (NMD). Furthermore, lipids were measured. Multivariate linear regression analysis was applied to address the research question. RESULTS Treatment with CEE+MPA resulted in an improvement in FMD of 2.0% (95% CI: -0.1; 4.1). CEE/MPA reduced total cholesterol with 13% (95% CI: -18%; -7%), LDL-cholesterol with 23% (95% CI: -30%; -15%) and lipoprotein(a) (Lp(a)) with 14% (95% CI: -26%; -2%). The magnitude of the relation of CEE/MPA with endothelial function was attenuated to from 2.0 to 1.6% when change in Lp(a) was taken into account. Adjustments for other lipids or blood pressure did not attenuate the association. CONCLUSIONS The improvement in endothelial function in postmenopausal women treated with CEE+MPA appears to be partially mediated by change in Lp(a), and apparently not by changes in other lipids.

Abstinence from coffee leads to a fall in blood pressure.

The long-term effects of coffee use on blood pressure and the effects of two common brewing methods were studied for 12 weeks in 107 young normotensives. The subjects were randomly assigned to one of three groups, receiving either (1) 4-6 cups of filtered coffee per day, (2) 4-6 cups of boiled coffee per day, or (3) no coffee for a period of 9 weeks. During the 9 weeks of abstinence, systolic and diastolic blood pressure decreased. The fall in systolic blood pressure amounted to 4.9 mmHg, compared with the filter group (P = 0.02). There was no difference with either brewing method. Our findings suggest that abstinence from coffee may reduce blood pressure in young normotensive subjects.