Physical Activity Decreases Coffee-Related CV Events in Hypertension, Says HARVEST

Deborah Brauser

June 21, 2016

PARIS, FRANCE — Regular, moderate levels of physical activity may protect against previously reported associations between coffee consumption and cardiovascular outcomes in patients with hypertension, new research suggests[1].

Last fall, Dr Lucio Mos (Hospital of San Daniele del Friuli, Udine, Italy) presented somewhat-controversial results at the European Society of Cardiology (ESC) 2015 Congress that among >1200 young adults with stage 1 hypertension, those who drank one to three espressos per day ("moderate coffee drinkers") were three times more likely to have a CV event, especially an MI, within 10 years vs nondrinkers. And consuming four or more of the coffee drinks per day ("heavy drinkers") was associated with four times the risk.

Dr Lucio Mos

But further findings from the Hypertension and Ambulatory Recording Venetia Study (HARVEST), which were presented last week at the European Society of Hypertension (ESH) 2016 Annual Meeting, showed that the coffee–CV-event association was modulated by regular exercise. In fact, significantly fewer of the CV events that occurred during follow-up were in the active vs sedentary groups (P<0.001).

"The coffee-related difference in CV events was also significant among the sedentary but not in the active subjects with a Mantel-Haenszel chi-square of 7.9," noted Mos. In other words, "physical activity had a beneficial effect in these coffee drinkers."

Session comoderator Dr Adrian Brady (University of Glasgow, Scotland) told heartwire from Medscape that although the study was interesting, he has several remaining questions.

"Cholesterol didn't appear to be a risk factor in the cohort, and that's unusual for cardiovascular events," said Brady. It was also a young group, and Mos "didn't go into detail" about the type of CV events found. "I think there's a lot more to these data than what was presented today."

CV-Event Predictors and Protectants

Further details from Mos's ESC presentation were published in the June 1, 2016 issue of the International Journal of Cardiology[2].

For the current analysis, the investigators wanted to also examine physical-activity status in 1204 participants in HARVEST, which was initiated in 1990. All participants were enrolled at one of 17 centers in Italy, were between the ages of 18 and 45 years, and had systolic blood pressure (SBP) of 140-159 mm Hg at baseline.

Of these, 61.1% were found to be sedentary, 14.9% were considered to be mild exercisers, 14.9% were "amateurs," and 9.1% were competitive athletes.

Patient Characteristics According to Physical-Activity Group

Variable Sedentary Mild exercisers Amateurs Competitive athletes
Age, years 34.4 32.5 31.5 28.8
Men, % 66.5 73.5 83.3 97.3
Mean SBP, mm Hg 145.3 145.2 145.7 146.8
Mean DBP, mm Hg 94.1 93.3 93.1 90.9
BMI, kg/m2 25.8 24.7 24.9 24.6

When examining coffee consumption, 26.3% of all participants were abstainers (74% men; mean age 30.5 years; BMI 24.6 kg/m2), 63.8% were moderate drinkers (73% men; mean age 33.5 years; BMI 25.7 kg/m2), and 9.9% were heavy drinkers (72% men; mean age 36.8 years; BMI 26.1 kg/m2).

In the sedentary group, 22.6% were coffee abstainers, 67.4% were moderate drinkers, and 10% were heavy drinkers. In the three active groups, 31% to 33% were abstainers, 57% to 59% were moderate drinkers, and 10% were heavy drinkers.

After about 13 years of follow-up, "coffee drinking was a significant predictor of cardiovascular events" (n=74) in heavy drinkers vs abstainers (P=0.002), said Mos. And these events were significantly more common in the sedentary patients (7.2%) vs the active patients (3.6%).

Finally, multivariable analysis of risk reduction for CV events showed "there was a borderline coffee–physical-activity interaction" (P=0.05), Mos reported.

A Magic Bullet?

Interestingly, the question-and-answer follow-up during what was the conference's last session concentrated on the original report about the coffee consumption–CV event association—and not on the new finding that physical activity might attenuate that association in this patient population.

"Other published studies have found different results, that coffee isn't particularly a major CV-event risk factor," commented Brady. "Was your population different because they all had hypertension?"

"No," answered Mos. Instead, he noted that most meta-analyses include different types of coffee—whereas espresso is the predominant drink in the part of Italy where these participants were enrolled. "So it appears that our results are related to espresso coffee in young hypertensives. But exercise had an effect on all of that."

"What about in normotensive people?" asked Brady. "I'm just asking for the rest of us," he said with a smile. Mos noted that although the study was started in 1990 to look at patients with borderline hypertension, those data weren't examined in this analysis.

Brady later told heartwire that the major societies don't currently provide any guidance on coffee consumption, "but maybe just don't drink buckets of it every day." Overall, he said that although it's not yet known if these new findings "are biologically true, it's certainly worth discussing."

His comoderator, Dr James Sharman (University of Tasmania, Hobart, Australia) added that the suggestion that regular, moderate physical activity could be protective against CV events, regardless of any association with coffee, isn't surprising.

"We know that exercise works above and beyond the whole blood-pressure reduction and into the whole metabolic system," said Sharman. "Exercise really is the magic bullet that helps. The only negative, perhaps, is in the unaccustomed elderly with a coexisting coronary artery disease."

Mos, Brady, and Sharman reported no relevant financial relationships.

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