How new endometriosis guidelines will improve diagnosis, treatment

 

• Researchers in Europe have created new guidelines for diagnosing and treating endometriosis.
• They have made significant updates to five key areas in managing the condition, including diagnosis, treatment, and recurrence.
• The new guidelines could help patients and clinicians better understand and manage the condition.

Endometriosis is a condition in which tissue similar to the lining inside the uterus grows outside the uterus. It affects around 190 millionTrusted Source — or 10% — of women and girls of reproductive age worldwide.

Although some people with endometriosis are asymptomatic, common symptoms include:

• painful cramping, similar to menstrual cramps
• long-term lower back and pelvic pain
• abnormal periods
• bowel and urinary problems, including pain, diarrhea, constipation, and bloating
• blood in the stool or urine
• nausea and vomiting
• fatigue
• pain during intercourse
• spotting or bleeding between periods
• infertility

While this is a common condition, people often only receive a diagnosis for it 8-12 yearsTrusted Source after symptom onset. More specific guidelines could improve diagnosis and treatment for people with the condition.

In a recent report, the European Society of Human Reproduction and Embryology (ESHRE) developed new clinical practice guidelines for diagnosing and treating endometriosis.

“These guidelines offer better ways to manage and treat endometriosis for physicians and hope and comfort for millions of women who have felt frustrated and desperate by this debilitating disease,” Dr. Sherry Ross, OB/GYN and Women’s Health Expert at Providence Saint John’s Health Center in Santa Monica, CA, told Medical News Today.

Major changes

Diagnosis

In the previous 2014 guidelines, laparoscopy — a surgical procedure involving small inclusions in the abdomen to insert a camera — was considered the gold standard diagnostic tool.

Due to recent advancements in imaging modalities, operative risk, limited access to highly-qualified surgeons, and financial implications, the ESHRE now only recommends laparoscopy if imaging results are negative and treatments unsuccessful or inappropriate.

Pain treatment

The present guidelines now recommend GnRH agonist or GnRH antagonist treatments — which prevent the ovaries from making sex hormones by desensitizing the pituitary gland — as a second-line treatment option.

They also say that NSAIDs may aid postoperative pain, the guidelines note that this may affect conception if taken continuouslyTrusted Source.

Infertility treatment

Extended use of GnRH agonists before assisted reproduction techniques (ARTs) — including in vitro fertilization — is no longer recommended to increase fertility due to unclear benefits.

Meanwhile, the Endometriosis Fertility Index (EFI) was added as a treatment step to help patients decide how to achieve pregnancy postsurgery.

Recurrence

The current guidelines recommend hormone treatments, including combined hormonal contraceptives for at least 18-24 months after surgery to prevent a recurrence.

They add that ART does not increase recurrence in women with deep endometriosisTrusted Source — a single nodule larger than 1 centimeter (cm) in diameter outside the uterus or close to the lower 20 cm of the bowel.

In conversation with MNT, Dr. Yen Hope Tran, OB/GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, noted that the guidelines also recommend surgeons “perform cystectomy instead of drainage and coagulation, as cystectomy reduces recurrence of endometrioma and endometriosis-associated pain.”

Adolescence

“Often, endometriosis manifests in adolescence, even early adolescence, but teens are unlikely to know that their pain and other symptoms are not the norm,” said Dr. Tran. “Period pain during this time is not normal.”

“Teens and their physicians often don’t address endometriosis — or endo symptoms — in the few meetings they are likely to have. I find it useful to ask about them having to miss classes/skip school because of their symptoms,” she added.

When diagnosing and treating adolescents, the guidelines recommend clinicians carefully investigate possible risk factors for endometriosis, including positive family history, obstructive genital malformations, early first menstruation, and a short menstrual cycle.

To treat endometriosis in adolescents, they recommend hormonal contraceptives or progesterone as first-line hormone therapy.

The American College of Obstetricians and Gynecologists recommends NSAIDs as the mainstay of pain relief for adolescents with endometriosis.

The World Health Organization (WHO)Trusted Source also recommends that if GnRH agonists are considered for adolescents and young women, the potential side effects and long-term health risks should first be discussed with a clinician in a secondary or tertiary setting.

“[The guidelines emphasize] preservation of fertility. Adolescents with endometriosis should be informed of the risk of becoming infertile so that they can make a more informed decision about early surgical intervention, preservation of oocytes, and other steps should they ever want to have children,” said Dr. Tran.

The ESHRE hopes that the new guidelines will assist both patients and healthcare professionals in better understanding and dealing with endometriosis.

When asked what the main points are for patients and clinicians to be aware of from these guidelines, Dr. Tran said:

“Endometriosis recurs quite frequently, and no one treatment is appropriate for every patient or every case. Later in life, different treatments may be called for. You’re never out of the woods with endometriosis. Damage from endo continues to cause problems for women even after menopause,” she explained.

“Talk to your doctor, don’t put off treatment. Relief from symptoms is possible. Preservation of fertility needs to start immediately; endometriosis is serious and should be taken seriously,” she concluded.

Source: Medical News Today

CPR rates in Black, Hispanic communities: Is bias to blame?

 

• A new study shows that Black and Hispanic individuals are less likely than their white counterparts to receive cardiopulmonary resuscitation (CPR) from a bystander after having a cardiac arrest at home or in a public place.
• These differences may partly explain lower survival rates in Black and Hispanic individuals who have a cardiac arrest in out-of-hospital settings.
• The disparities, the study found, were not influenced by the racial composition of neighborhoods, suggesting that increasing CPR training in Black and Hispanic communities may not be adequate to address the problem.

Black and Hispanic individuals are less likely than white individuals to receive CPR from a bystander upon experiencing a cardiac arrest outside a hospital, a recent study analyzing nationwide data suggests.

Moreover, the study found a lower number of bystanders administered CPR to Black and Hispanic individuals in both predominantly white neighborhoods and Black/Hispanic majority and integrated communities.

The study’s lead author Dr. Paul Chan, professor of medicine at the University of Missouri, told Medical News Today:

“These findings raise questions about whether simply increasing CPR training in Black and Hispanic communities is sufficient, as Black and Hispanic individuals with a cardiac arrest in Black/Hispanic communities were still less likely to receive potentially life-saving CPR than white individuals in these communities.”

The study will be presented at the upcoming American College of Cardiology conference.

Bystander CPR and survival rates

A cardiac arrestTrusted Source occurs when the heart suddenly stops beating, resulting in the disruption of blood supply to the body.

According to an American Heart Association reportTrusted Source in 2019, almost 1,000 individuals experienced a cardiac arrest outside of a hospital each day in the United States. Moreover, the survival rate for individuals who experience an out-of-hospital cardiac arrest (OHCA) is less than 10%Trusted Source.

Immediately receiving CPR from a bystander before emergency medical services (EMS) personnel arrives can increase the likelihood of survival by 2-3 timesTrusted Source.

Previous studies (1Trusted Source, 2Trusted Source) have shown that Black and Hispanic individuals have worse survival outcomes after an OHCA than white individuals.

Racial differences in the rates of CPR by a bystander or onlooker could potentially contribute to these differences in survival outcomes after OHCA.

The present study aimed to compare the bystander CPR rates in Black and Hispanic individuals with their white counterparts.

Racial disparities in bystander CPR

In the present study, the researchers used data from a large national registry, the Cardiac Arrest Registry Enhancing Survival (CARES)Trusted Source. The CARES registry contains nationwide data on out-of-hospital cardiac arrests, including where the event occurred, patient outcomes, and demographic data.

Via CARES, the researchers obtained data on over 110,000 OHCAs witnessed by a bystander.

The researchers found that Black and Hispanic individuals were 26% less likely to receive CPR from a bystander than white individuals when the OHCA occurred at home.

Similarly, when the witnessed OHCA occurred in a public place, Black and Hispanic individuals had a 41% lower likelihood of receiving CPR from a bystander than their white counterparts

Neighborhood characteristics

The researchers also examined whether the neighborhood’s racial composition where the cardiac event occurred influenced the bystander CPR rates among different racial groups.

They found that Black and Hispanic individuals were less likely to receive CPR from a bystander than white individuals at home or in public, regardless of the neighborhoods being predominantly white, Black/Hispanic, or integrated.

Previous studiesTrusted Source suggest that individuals who experience a cardiac arrest in a high-income neighborhood are more likely to receive bystander CPR. However, neighborhood income levels did not influence the racial disparities in the bystander CPR rates in the present study.

Potential reasons for disparities

Although the researchers did not investigate the reasons behind these racial disparities, they think the differences in CPR training rates and racial bias may underlie these differences.

For instance, lower rates of CPR training among Black and Hispanic communities due to constraints of cost and time and difficulties accessing training locations could partly explain these results.

Language barriers and fear of police may also deterTrusted Source bystanders belonging to racially minoritized groups from making a 911 call and performing dispatcher-assisted CPR.

Implicit or explicit bias could also explain the lower bystander CPR rates in Black and Hispanic individuals.

“Organizations [that] conduct CPR training to the lay public (American Heart Association and American Red Cross) will first need to make CPR training more accessible to low-income and non-white communities. This includes waiving training fees and conducting training in non-traditional settings (e.g., Black churches, Hispanic community centers),” said Dr. Chan.

“Second, dispatcher-assisted CPR when 9-1-1 is called should be made universally available, particularly in poor and non-white communities where bystander CPR rates are lowest,” he continued.

“Third, we need to diversify mannequins and individuals portrayed in media and training materials of CPR. Many of these use white mannequins or white bystanders in their photos, and we need to diversify the representation of these to ensure that the importance of bystander CPR reaches people who are not white,” he added.

The researchers noted that despite these disparities, their results show that rates of bystander CPR across all racial groups remain low.

Source: Medical News Today

Signs of aging safely reversed in mice

 

• Scientists have previously shown that some aspects of cell aging can be reversed in mice.
• However, this was demonstrated in mice with premature aging.
• Other experiments also resulted in the mice developing lethal tumors.
• In the present study, the researchers altered the method by which they reversed the signs of aging in mice, and did so over a longer period of time.
• The researchers found that this method safely reversed various signs of aging in the mice.

The study, published in the journal Nature Aging, lays the ground for research that explores the possibility of translating the findings into humans.

Aging

People have traditionally thought of aging as an inevitable part of life. But since the seminal work of Cynthia Kenyon in the ’90s, researchers have also become aware that aging is under genetic control.

Scientists continue to be interested in finding out whether the negative effects of aging can be reduced or reversed entirely.

Currently, 16% of the United States population is 65 years or older. By 2050 this is expected to reach 22%.

The Centers for Disease Control and Prevention (CDC) noteTrusted Source that aging increases a person’s risk of various serious chronic illnesses, such as cancer, dementia, type 2 diabetes, and heart disease.

The National Institute on AgingTrusted Source points out that there are various things a person can do to help reduce the effects of aging.

These include staying physically active, eating a healthy diet with lots of vegetables, fruit, and whole grains, getting a good amount of quality sleep, avoiding smoking and drinking alcohol, and regularly seeing a doctor.

In 2020 the World Health Organization (WHO) published a baseline report for the Decade of Healthy AgeingTrusted Source, highlighting how countries can go about ensuring health and well-being as people age.

Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, says thatTrusted Source “humans now live longer than at any time in history. But adding more years to life can be a mixed blessing if it is not accompanied by adding more life to years.”

“The Baseline Report for the Decade of Healthy Ageing has the potential to transform the way policy-makers and multiple service providers engage with older adults. We have to work together, to foster the abilities and well-being of our older generations, who continue to give us so much.”

Reprogramming cells

As well as lifestyle and policy changes, scientists are also exploring whether new types of medical interventions could reduce the physiological effects of aging.

The authors behind the present study have previously found that epigenetic markers in mice could be reprogrammed using the molecules Oct4, Sox2, Klf4, and cMyc. These molecules, known as Yamanaka factors, increased the lifespan and reduced the effects of aging in mice with premature aging.

Medical News Today spoke with Prof. Juan Carlos Izpisua Belmonte, of the Gene Expression Laboratory at the Salk Institute for Biological Studies, San Diego, CA, and a corresponding author of the present study.

“In the 2016 paper, we developed a protocol and showed for the first time that Yamanaka factors could be expressed in mice safely without generating cancer. Moreover, in our previous study, we used a premature aging mouse model to demonstrate that Yamanaka factors can extend the lifespan of these mice by preventing the accumulation of aging phenotypes in cells and tissues.”

“However, we did not know if expressing the Yamanaka factors for an extended period of time in animals without any preexisting pathologies will work and whether it would be safe. The goal of the current study was to establish whether long-term partial reprogramming would have a positive or negative impact on a wild-type animal’s health,” said Prof. Izpisua Belmonte.

Mouse models

To do this, Prof. Izpisua Belmonte and his colleagues split the mice into three groups. The first group received Yamanaka factors from 15 to 22 months or around 50 to 70 years in human terms.

The second group received the Yamanaka factors from 12 to 22 months or 35 to 70 in human years.

The third group was treated for a single month at 25 months or 80 years in human terms.

Safe reversal of aging effects

The researchers found that compared with mice that acted as a control, the mice who received the Yamanaka factors did not develop cancer or see any blood cell or neurological changes.

Further, the mice that received the Yamanaka factors for a number of months showed various reversals in the effects of aging.

The kidneys and skin of the mice resembled those of younger mice, their skin healed from wounds without producing as much scarring, and the scientists did not observe the usual metabolic changes in the blood typically seen in older animals.

The animals treated for just a single month late in life did not see these effects.

Prof. Izpisua Belmonte said there were still necessary steps before the research could be tested in humans.

“The translation of our approach to humans requires developing ways to deliver the factors and controlling the levels and how long the factors are expressed. These steps will allow [us] to demonstrate the safe delivery of the factors, a critical aspect before we could start thinking in clinical trials.”

Nonetheless, the findings provide exciting evidence that the technique could have benefits far beyond the reversal of the effects of aging.

“After our initial 2016 study, our lab, as well as several other laboratories around the world, have used the same approach to demonstrate improvement in the regeneration of different tissues in mice and rejuvenation of human cells.”

“All these studies further prove that the controlled expression of Yamanaka factors for cell reprogramming could benefit diverse conditions and might be a general medicine approach in the future for various complications that arise during life,” said Prof. Izpisua Belmonte.

Source: Medical News Today

Does selenium really slow aging?

 Selenium is a trace mineral, which means the body only requires it in very small amounts. It is naturally present in many foods and is also available as a dietary supplement.

The majority of selenium from our diet gets stored in muscle tissue, though the thyroidTrusted Source is the organ with the highest concentration.

Selenium is an important componentTrusted Source of enzymes and proteins — known as selenoproteins — that play a key role in reproduction, thyroid hormone metabolism, and DNA synthesis.

Selenoproteins also act as powerful antioxidants that help protect against damaging particles in the body called free radicals.

Free radicalsTrusted Source are unstable atoms produced naturally in the body as a byproduct of normal functions within the body. They cause damage to cell membranes and DNA. Over time, this can lead to inflammation, premature skin aging, and a host of age-associated diseases.

Anti-aging benefits of selenium

Biological agingTrusted Source is a complex process that involves molecular damage, metabolic imbalance, immune system changes, and increased susceptibility to environmental stressors and disease.

According to a reviewTrusted Source from 2018, selenium can fight aging and prevent age-related health issues, such as tumors, cardiovascular disease, and neuropsychiatric disorders. Some researchers also believe that selenium can reduce chronic inflammationTrusted Source, which is closely related to aging.

According to some research, selenoproteins are primarily responsible for many of the health benefits of selenium.

For example, one 2021 review found that selenoproteins play a key role in controlling and removing misfolded proteinsTrusted Source, which accumulate as we age. Specialists note that the accumulation of misfolded proteins is a common characteristic of aging and age-related diseases, including type 2 diabetes and Alzheimer’s disease.

Experts also believe that selenium protects the skin against ultraviolet (UV) oxidative stress by stimulating the selenium-dependent antioxidant enzymes glutathione peroxidase (GPx) and thioredoxin reductaseTrusted Source (TDR). TDR is located in the plasma membrane of epidermal keratinocytes. This may potentially combat aging skin caused by UV exposure.

Moreover, a newer study from 2020 found that increased dietary intakes of selenium are associated with longer telomeres. This study found that every 20 microgram increase in dietary selenium was associated with a 0.42% longer telomere length in participants over the age of 45.

Telomeres are “protective caps” located on the ends of our chromosomes that affect how quickly cells age. Some experts consider telomere length as an informative biomarker of aging.

ResearchersTrusted Source also believe that higher levels of selenium are associated with longevity. The all-cause mortality of older adults with low selenium levels is significantly higher than that of the elderly with a high level of selenium.

For example, centenarians often appear to have higher systemic levels of selenium and iron while having lower levels of copper than other older people.

However, it is important to note that results remain conflicting and more research on the topic is needed. Some studies — such as the one referred to above — suggest that low levels of selenium may actually promote longevity.

Other health benefits

Selenium may also play an important role in the protection against certain age-related diseases.

Heart disease

One meta-analysisTrusted Source found that people with lower selenium levels are at a higher risk of coronary heart disease. In contrast, a review Trusted Sourceof trials that used only selenium supplementation for the primary prevention of heart disease found no statistically significant effects of selenium on both fatal and nonfatal cardiovascular events.

Although some research appears promising, there is not enough evidenceTrusted Source to support the routine use of selenium supplements, especially in those who are obtaining enough from food to prevent heart disease at this time.

Cancer

There is a notion that selenium may play a role in cancer prevention thanks to its ability to protect cells against DNA damage and mutations. However, the evidence around this remains conflicting.

According to a 2018 reviewTrusted Source of 83 studies, there is no solid research to suggest selenium from diet or supplements prevents cancer in humans.

In fact, some trialsTrusted Source suggest that selenium supplementation may increase the risk of non-melanoma skin cancer and type 2 diabetes.

Thyroid disease

Selenium plays a key role in thyroid function. Some studiesTrusted Source suggest that having optimal selenium levels can protect against thyroid disease and preserve overall health.

However, according to the Office of Dietary SupplementsTrusted Source, additional research is needed to determine whether selenium supplements can treat or prevent thyroid disease.

Cognitive decline

Because serum selenium levels decline with age, marginal or deficient selenium concentrations may be associated with age-related declines in brain functionTrusted Source. Experts believe this might be due to selenium’s antioxidant properties.

Still, more research is needed to determine if selenium supplementation can help treat or prevent age-related cognitive decline in older adults.

Source: Medical News Today

Through My Eyes: Why endometriosis almost killed me

 Ranging from discrimination based on gender and weight to class and race — it can seem as though we are speaking to a wall when trying to express our conditions. Doctors across the board seem to disregard anything related to menstrual cycles, calling various symptoms “normal.”

But what is normal about debilitating pain, projectile vomiting, and heavy, intense menses? By the time I received my diagnosis, I was already at severe stage 4 endometriosis, and the reality is: Had I been listened to much earlier, this would likely have been a very different outcome.

The refusal of adequate endometriosis care is what kept me in the same space — chasing answers, coming up empty, and being dismissed for years.

‘I felt like talking about my illness was a weakness’

One of the things that stands out to me is the fact that whenever I would express distress or any emotion that didn’t fit the “strong Black woman” trope, even as a teenager, I would be looked at as if I had suddenly sprouted a second head.

The doctor would express some variation of the same sentiment: “Well, yes, there’s no cure, but it’s not cancer, and it won’t kill you.”

It isn’t that simple. I still felt sick every day, and every day is a challenge. The lack of serious intervention from healthcare professionals meant that my condition continued to deteriorate, and the symptoms I complained about were not attended to.

If I expressed difficulties with walking, lower back pain, or headaches, they would be dismissed as unrelated to my condition.

In 2021 my condition had started to take hold of me. I was in constant severe pain, I battled with fatigue, I struggled to walk without pain, my abdomen became so sensitive that I couldn’t wear pants or anything with a waistband.

I went to see a new specialist in the hope that I may get the necessary care and that my life would return to some semblance of normalcy. The specialist confirmed that my condition was quite advanced and severe. He was transparent and let me know the surgery may not be entirely life-changing because of the stage that the endometriosis had reached.

‘I had the most severe case the specialist had ever seen’

He let me know that it would likely be a very long surgery and that they estimated it would take around 5 hours. I woke up in the Intensive Care Unit (ICU), with medical equipment all over me, attached to me, and around me.

The nurse let me know that I had been in surgery for an entire 12 hours, and because of that, they needed to keep me in ICU to monitor my condition.

I was floored. In my entire medical experience, doctors had always shut me down and told me that while this was an incurable chronic disease, it wasn’t dangerous and it wouldn’t kill me. Yet I found myself exceptionally unwell and in ICU.

Source: Medical News Today

When it comes to sleep, it’s quality over quantity

 Some people are gifted with genes that pack the benefits of slumber into an efficient time window, keeping them peppy on only four or six hours of sleep a night, according to researchers at UC San Francisco. In addition, the scientists said, these "elite sleepers" show psychological resilience and resistance to neurodegenerative conditions that may point the way to fending off neurological disease.

"There's a dogma in the field that everyone needs eight hours of sleep, but our work to date confirms that the amount of sleep people need differs based on genetics," said neurologist Louis Ptacek, MD, one of the senior authors on the study, which appears in iScience on March 15, 2022 "Think of it as analogous to height; there's no perfect amount of height, each person is different. We've shown that the case is similar for sleep."

For over a decade, Ptacek and co-senior author, Ying-Hui Fu, PhD, both members of the UCSF Weill Institute for Neurosciences, have been studying people with Familial Natural Short Sleep (FNSS), the ability to function fully on -- and have a preference for -- four to six hours of sleep a night. They've shown that it runs in families and, thus far have identified five genes across the genome that play a role in enabling this efficient sleep. There are still many more FNSS genes to find, the researchers said.

This study tested Fu's hypothesis that elite sleep can be a shield against neurodegenerative disease. Her ideas contrast somewhat with current thinking that, for many people, lack of sleep can accelerate neurodegeneration. The difference, Fu said, is that with FNSS, the brain accomplishes its sleep tasks in a shorter time. In other words, less time spent efficiently sleeping may not equate to a lack of sleep.

The team chose to look at mouse models of Alzheimer's disease because that condition is so prevalent, said Fu. They bred mice that had both short-sleep gene and genes that predisposed them to Alzheimer's and found that their brains developed much less of the hallmark aggregates associated with dementia. To confirm their findings, they repeated the experiment using mice with a different short-sleep gene and another dementia gene and saw similar results.

Fu and Ptacek believe that similar investigations of other brain conditions would show the efficient-sleep genes conferring comparable protections. improving peoples' sleep could delay progression of disease across a whole spectrum of conditions, they said.

"Sleep problems are common in all diseases of the brain," she said. "This makes sense because sleep is a complex activity. Many parts of your brain have to work together for you to fall asleep and to wake up. When these parts of the brain are damaged, it makes it harder to sleep or get quality sleep."

Understanding the biological underpinnings of sleep regulation could identify drugs that will help ward off problems with sleep disorders. In addition, improving sleep in healthy people may sustain wellbeing and improve the quality of time we each have, the researchers said. But pursuing the many genes involved is a long game that they liken to putting together a thousand-piece jigsaw puzzle.

"Every mutation we find is another piece," said Ptacek. "Right now we're working on the edges and the corners, to get to that place where it's easier to put the pieces together and where the picture really starts to emerge."

Despite the long road ahead, there's already promise in some of the few genes they've identified. At least one of them can be targeted with existing drugs that might be repurposed. Their hope is that within the next decade, they'll have helped facilitate new treatments that allow people with brain disorders to get a better night's rest.

"This work opens the door to a new understanding of how to delay and possibly prevent a lot of diseases," said Fu. "Our goal really is to help everyone live healthier and longer through getting optimum sleep."

Additional authors on the study include Qing Dong, Nicholas W Gentry, Thomas McMahon, Maya Yamazaki, Lorena Benitez-Rivera, and Tammy Wang, all of UCSF and Li Gan of Weill Cornell Medicine.

Source: Sciencedaily

Good news for coffee lovers: Daily coffee may benefit the heart

 Drinking coffee -- particularly two to three cups a day -- is not only associated with a lower risk of heart disease and dangerous heart rhythms but also with living longer, according to studies being presented at the American College of Cardiology's 71st Annual Scientific Session. These trends held true for both people with and without cardiovascular disease. Researchers said the analyses -- the largest to look at coffee's potential role in heart disease and death -- provide reassurance that coffee isn't tied to new or worsening heart disease and may actually be heart protective.

"Because coffee can quicken heart rate, some people worry that drinking it could trigger or worsen certain heart issues. This is where general medical advice to stop drinking coffee may come from. But our data suggest that daily coffee intake shouldn't be discouraged, but rather included as a part of a healthy diet for people with and without heart disease," said Peter M. Kistler, MD, professor and head of arrhythmia research at the Alfred Hospital and Baker Heart Institute in Melbourne, Australia, and the study's senior author. "We found coffee drinking had either a neutral effect -- meaning that it did no harm -- or was associated with benefits to heart health."

Kistler and his team used data from the UK BioBank, a large-scale prospective database with health information from over half a million people who were followed for at least 10 years. Researchers looked at varying levels of coffee consumption ranging from up to a cup to more than six cups a day and the relationship with heart rhythm problems (arrhythmias); cardiovascular disease, including coronary artery disease, heart failure and stroke; and total and heart-related deaths among people both with and without cardiovascular disease. Patients were grouped by how much coffee they reported drinking each day: 0, <1, 1, 2-3, 4-5, >5 cups/day. Coffee drinking was assessed from questionnaires completed upon entry into the registry. Overall, they either found no effect or, in many cases, significant reductions in cardiovascular risk after controlling for exercise, alcohol, smoking, diabetes and high blood pressure that could also play a role in heart health and longevity.

For the first study, researchers examined data from 382,535 individuals without known heart disease to see whether coffee drinking played a role in the development of heart disease or stroke during the 10 years of follow up. Participants' average age was 57 years and half were women. In general, having two to three cups of coffee a day was associated with the greatest benefit, translating to a 10%-15% lower risk of developing coronary heart disease, heart failure, a heart rhythm problem, or dying for any reason. The risk of stroke or heart-related death was lowest among people who drank one cup of coffee a day. Researchers did observe a U-shaped relationship with coffee intake and new heart rhythm problems. The maximum benefit was seen among people drinking two to three cups of coffee a day with less benefit seen among those drinking more or less.

The second study included 34,279 individuals who had some form of cardiovascular disease at baseline. Coffee intake at two to three cups a day was associated with lower odds of dying compared with having no coffee. Importantly, consuming any amount of coffee was not associated with a higher risk of heart rhythm problems, including atrial fibrillation (AFib) or atrial flutter, which Kistler said is often what clinicians are concerned about. Of the 24,111 people included in the analysis who had an arrhythmia at baseline, drinking coffee was associated with a lower risk of death. For example, people with AFib who drank one cup of coffee a day were nearly 20% less likely to die than non-coffee drinkers.

"Clinicians generally have some apprehension about people with known cardiovascular disease or arrhythmias continuing to drink coffee, so they often err on the side of caution and advise them to stop drinking it altogether due to fears that it may trigger dangerous heart rhythms," Kistler said. "But our study shows that regular coffee intake is safe and could be part of a healthy diet for people with heart disease."

Although two to three cups of coffee a day seemed to be the most favorable overall, Kistler said that people shouldn't increase their coffee intake, particularly if it makes them feel anxious or uncomfortable.

"There is a whole range of mechanisms through which coffee may reduce mortality and have these favorable effects on cardiovascular disease," he said. "Coffee drinkers should feel reassured that they can continue to enjoy coffee even if they have heart disease. Coffee is the most common cognitive enhancer -- it wakes you up, makes you mentally sharper and it's a very important component of many people's daily lives."

So how might coffee beans benefit the heart? People often equate coffee with caffeine, but coffee beans actually have over 100 biologically active compounds. These substances can help reduce oxidative stress and inflammation, improve insulin sensitivity, boost metabolism, inhibit the gut's absorption of fat and block receptors known to be involved with abnormal heart rhythms, Kistler said.

In a third study, researchers looked at whether there were any differences in the relationship between coffee and cardiovascular disease depending on whether someone drank instant or ground coffee or caffeinated or decaf. They found, once again, two to three cups a day to be associated with the lowest risk of arrhythmias, blockages in the heart's arteries, stroke or heart failure regardless of whether they had ground or instant coffee. Lower rates of death were seen across all coffee types. Decaf coffee did not have favorable effects against incident arrhythmia but did reduce cardiovascular disease, with the exception of heart failure. Kistler said the findings suggest caffeinated coffee is preferable across the board, and there are no cardiovascular benefits to choosing decaf over caffeinated coffees.

Source: Sciencedaily