Monday, December 30, 2013

Coffee Increases or Decreases Risk of Heart Attacks?

The Journal of the American Medical Association found that drinking coffee with caffeine (not decaf) may raise the risk of heart attacks.

The Journal of the American Medical Association found that drinking coffee with caffeine (not decaf) may lower the risk of heart attacks.

Make up your mind?

Actually both findings are correct.

Whether coffee is heart-healthy or heart-harmful seems to depend on whether you have a "slow" or a "fast" version of the gene that tells the liver how to use an enzyme known as CYP1A2. This enzyme breaks down the caffeine in coffee.

If your liver can break down caffeine quickly, then the body benefits from all the antioxidants coffee provides. If your liver breaks down caffeine slowly, then the benefits of coffee's antioxidants is more than offset by the stress on the heart caused by caffeine.

But that's not the entire story.

Even if you have a "fast" CYP1A2 gene, the liver also uses the enzyme it codes to break other potential toxins besides caffeine. The reason some people with asthma breathe easier when they drink caffeinated beverages, for instance, has to do with the fact that the enzyme is busy breaking down caffeine so it doesn't break down the active chemicals in asthma drugs.

The same principle explains why some coffee drinkers experience increased blood pressure when they take calcium channel blockers or angiotensin II antagonists to lower blood pressure. The CYP1A2 is occupied clearing out the medication, so it can't clear out the caffeine.

So how do you know whether caffeine increases or decreases your risk of heart attack?

It seems logical that if drinking coffee after dinner keeps you up at night, you might have a "slow" version of the enzyme, but it's also possible your brain is just very sensitive to caffeine.

When I've traveled and had to drive, I could drink coffee in the morning and it would keep me "zinged" past bedtime, so I now already know my liver's not breaking down the caffeine. Having avoided caffeine considering it not a good substance, I now realize that it was a wise decision for me.

Right now, the only way to know for sure is through genetic testing to determine how your body makes CYP1A2. (More info on testing.)

Cornelis MC, El-Sohemy A, Kabagambe EK, Campos H. Coffee, CYP1A2 genotype, and risk of myocardial infarction. JAMA. 2006 Mar 8;295(10):1135-41.

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