title: The coffee paradox in stroke: Increased consumption linked with fewer strokes.
abstract: OBJECTIVE
  To determine the association in amount of daily coffee consumption with incidence of stroke in a broad cohort, considering other vascular risk factors.
  
  
  METHODS
  We utilized the Third National Health and Nutrition Examination Survey (1988-1994; NHANES III) data on participants aged ≥17 years old to examine coffee consumption and stroke. Multivariate logistic regression models related the amount of coffee use reported in a food frequency questionnaire with stroke, controlling for other vascular risk factors.
  
  
  RESULTS
  Of 33 994 NHANES III subjects, coffee consumption and stroke data in adults ≥17 years old were available in 19 994. Daily coffee consumption ranged from 0 to 20 (median 1) cups and 644 (3.2%) participants had a stroke diagnosed by a physician. Coffee intake varied with age, gender, and ethnicity (P < 0.001). Interestingly, heart failure, diabetes, and hypertension were less frequent, and high cholesterol more frequent in those consuming ≥3 cups per day (P < 0.001). Smoking was more frequent in all coffee drinkers (P < 0.0001). Multivariate analyses revealed an independent effect of heavier coffee consumption (≥3 cups/day) on reduced stroke (OR 0.44, 95% CI 0.22-0.87, P < 0.02) in healthy subjects that was attenuated by vascular risk factors (OR 0.78, 95% CI 0.58-1.07, P ≈ 0.12).
  
  
  CONCLUSIONS
  Heavier daily coffee consumption is associated with decreased stroke prevalence, despite smoking tendency in heavy coffee drinkers.
authors.affiliation: a Department of Neurology , UCLA Stroke Center , Los Angeles , CA , USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: b Roxanna Todd Hodges Comprehensive Stroke Clinic , University of Southern California , Los Angeles , CA , USA.
authors.forename: Nerses
authors.initials: N
authors.lastname: Sanossian
authors.affiliation: b Roxanna Todd Hodges Comprehensive Stroke Clinic , University of Southern California , Los Angeles , CA , USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Fu
authors.affiliation: c Department of Biomathematics , UCLA , Los Angeles , CA , USA.
authors.forename: He-Jing
authors.initials: HJ
authors.lastname: Wang
authors.affiliation: d Department of Epidemiology, School of Public Health , UCLA , Los Angeles , CA , USA.
authors.forename: Lenore
authors.initials: L
authors.lastname: Arab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003069:Coffee / Q000009:adverse effects; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005260:Female; D055951:Functional Food; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology / Q000209:etiology; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D003069:Coffee
keywords: Caffeine; Coffee; Ischemia; Risk factors; Stroke