title: Transient exposure to coffee as a trigger of a first nonfatal myocardial infarction.
abstract: BACKGROUND
  The effects of coffee on myocardial infarction are uncertain. We hypothesize that coffee in the presence of predisposing factors can induce a cascade of events that, through sympathetic nervous activation, can induce the onset of myocardial infarction.
  
  
  METHODS
  We recruited 503 incident cases of nonfatal myocardial infarction between 1994 and 1998 in Costa Rica. We used a case-crossover design to calculate relative risks (RRs) and 95% confidence intervals (95% CIs).
  
  
  RESULTS
  The RR of myocardial infarction in the hour after coffee intake was 1.49 (95% CI = 1.17-1.89). Occasional coffee drinkers (< or =1 cup/day, n = 103) had a RR of myocardial infarction of 4.14 (2.03-8.42), moderate coffee drinkers (2-3 cups/day, n = 280) had a RR of 1.60 (1.16-2.21), and heavy coffee drinkers (> or =4 cups/d, n = 120) had a RR of 1.06 (0.69-1.63; P = 0.006, test of homogeneity). Patients with 3 or more risk factors (n = 101) had a RR of myocardial infarction of 2.10 (1.30-3.39), whereas patients with fewer than 3 risk factors (n = 396) had a RR of 1.39 (1.04-1.82; P = 0.15, test of homogeneity); and RR was 1.72 (1.30-2.30) among sedentary patients compared with 1.07 (0.66-1.72) among nonsedentary (P = 0.10, test of homogeneity).
  
  
  CONCLUSIONS
  The findings indicate that coffee intake may trigger myocardial infarction. The association is particularly strong among people with light/occasional intake of coffee (< or =1 cup/day), with sedentary lifestyle, or with 3 or more risk factors for coronary heart disease.
authors.affiliation: Department of Community Health, Brown University, Providence, RI 02912, USA. Ana_Baylin@btrown.edu
authors.forename: Ana
authors.initials: A
authors.lastname: Baylin
authors.forename: Sonia
authors.initials: S
authors.lastname: Hernandez-Diaz
authors.forename: Edmond K
authors.initials: EK
authors.lastname: Kabagambe
authors.forename: Xinia
authors.initials: X
authors.lastname: Siles
authors.forename: Hannia
authors.initials: H
authors.lastname: Campos
mesh_terms: D000208:Acute Disease; D000368:Aged; D002110:Caffeine / Q000009:adverse effects*; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D003069:Coffee / Q000009:adverse effects*; D003364:Costa Rica / Q000453:epidemiology; D018592:Cross-Over Studies; D005247:Feeding Behavior / Q000502:physiology; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000453:epidemiology*; D012306:Risk; D011795:Surveys and Questionnaires
chemical_list: D000697:Central Nervous System Stimulants; D003069:Coffee; D002110:Caffeine