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Abstract & Commentary
Source: Isaksen J, et al. Risk factors for aneurysmal subarachnoid hemorrhage: The tromso study. J Neurol Neurosurg Psychiatry. 2002;73:185-187.
Coffee, whether mocha cappuccino or dishwater swill, remains a staple of our diet, particularly among the overworked citizens of the medical community. Periodically, a dangerous epidemiological association emerges, such as a possible increased risk of pancreatic cancer, only to be debunked in further analysis. With a late night cup of joe in hand, we approach these new data.
Isaksen and associates studied individuals with aneurysmal subarachnoid hemorrhage (SAH) drawn from an overall study population of 52,792 in Tromso, Norway. There were 233 cases with SAH, however only 56 of these were confirmed by angiography or autopsy. A subset of the 56 had survey data taken prior to bleeding (n = 26) and were entered into final analysis. Each case was age and sex matched with 4 controls.
Systolic hypertension, cigarette smoking, and coffee intake were all associated with SAH. These factors remained significant in multivariate analysis with odds ratios of 2.46, 4.55, and 3.86 respectively. Coffee consumption was classified as either low < 5 or high > 5 cups a day. High quantities of coffee were consumed by 85% of cases but only 60% of controls (P = 0.004). Any cigarette smoking proved harmful, with current cigarette use emerging as the most powerful risk factor.
While hypertension and smoking have been previously associated with SAH, this is the first report of a role for coffee consumption. The methodology of the study, however, begs several further questions. Was the coffee caffeinated or decaffeinated? Are other caffeinated beverages harmful? What was the temporal relationship between coffee intake and the occurrence of SAH; was this an immediate or delayed effect? Is this risk relationship linear (ie, dose dependent) or is it restricted to only excess coffee consumption? Does coffee lead to aneurysm formation or does it precipitate rupture of existing lesions?
These data thus provoke more questions than they solve. Given that an excess of anything is best to be avoided, one might advise our 6-cup-of-coffee/day drinkers as well as ourselves, to perhaps cut down by a few. —Alan Z. Segal
Dr. Segal, Assistant Professor, Department of Neurology, Weill-Cornell Medical College, Attending Neurologist, New York Presbyterian Hospital, is Assistant Editor of Neurology Alert.