Drinking more coffee linked to reduced cognitive decline in people with atrial fibrillation

Drinking several cups of coffee a day may help prevent cognitive decline in people with atrial fibrillation (AFib or AF), according to new research published December 14, 2024 in the Journal of the American Heart Association, an open-access, peer – Reviewed Journal of the American Heart Association.

There are many myths floating around, but our research found no reason to discourage or prohibit a patient with AFib from drinking coffee. Instead, say, ‘Enjoy it, it might even be good for you!’”

Jürg H. Beer, MD, senior author of the study and professor of medicine and hematology, University of Zurich, Switzerland

Atrial fibrillation is the most common heart rhythm disorder in adults, affecting more than 5 million people in the U.S., according to the American Heart Association. The 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Treatment of Atrial Fibrillation notes that withholding caffeine to prevent cardiac arrhythmias has no benefit for people with AFib. The guideline also notes that abstaining from coffee could reduce symptoms in patients who report that caffeine causes or worsens their AFib symptoms, including fast heart rate, dizziness, fatigue and more.

“Regular coffee consumption is known to benefit cognitive performance in healthy people. The most common cardiac arrhythmia, atrial fibrillation, is known to independently increase the risk of dementia,” said Massimo Barbagallo, MD, lead author of the study and resident from the neurointensive care unit of the University Hospital Zurich. “So the question is whether coffee could offset the increased risk of cognitive impairment in people with AFib.”

According to U.S. federal dietary guidelines, three to five 8-ounce cups of coffee per day can be part of a healthy diet, but that only applies to regular black coffee. The American Heart Association warns that popular coffee-based drinks, such as lattes and macchiatos, are often high in calories, added sugars and fat.

The Swiss Atrial Fibrillation Cohort Study (Swiss-AF) is following more than 2,400 people in Switzerland who have been diagnosed with atrial fibrillation. Patients were enrolled between 2014 and 2017, completed several cognitive tests and reported how many cups of caffeinated coffee they drank in the past 12 months, regardless of added sweeteners, creams or flavors. Cup size was not standardized.

In this study, researchers analyzed those cognitive assessments and examined whether drinking coffee could prevent the cognitive decline that is a known danger of AFib. Because Alzheimer’s disease and AFib are associated with systemic inflammation, researchers also analyzed inflammatory markers.

The study found:

• In general, higher cognitive test scores were associated with higher coffee consumption.
• In particular, scores for processing speed, visuomotor coordination and attention improved significantly by 11% among coffee consumers compared to non-consumers.
• Cognitive age was calculated to be 6.7 years younger among those who drank the most coffee compared to those who drank the least.
• Inflammatory markers were more than 20% lower in participants who drank five cups daily than in participants who drank less than one cup per day.
• Researchers found no interaction between age, gender and coffee consumption.

“There was a very clear and consistent ‘dose-response’ relationship between drinking more coffee and performing better on several advanced cognitive tests,” Beer said. “Inflammatory markers decreased with higher coffee consumption, an association that persisted after considering variables such as age, gender, body mass index, smoking status, physical activity, and history of stroke.”

Researchers noted that previous studies suggest that the protective effects of regular coffee consumption against cognitive decline in the elderly may be attributed to caffeine and other active ingredients, including magnesium and vitamin B3 (niacin); or whether this may be due to coffee’s role in reducing chemicals that cause inflammation.

José A. Joglar, MD, FAHA, chair of the 2023 joint guideline on the treatment of atrial fibrillation, cautioned that this observational study cannot conclude that coffee actually prevents long-term cognitive decline.

“Other studies have shown that coffee has cognitive-enhancing functions across the board. However, this is not specific to the AFib population. We cannot conclude that coffee prevents long-term cognitive decline,” said Joglar, professor of Internal Medicine at the UT Southwestern. Dallas Medical Center. “Coffee does not appear to worsen AFib, so there is no need to stop drinking it. However, we cannot say that starting to drink coffee would prevent AFib or prevent long-term cognitive decline.”

The study’s limitations include the fact that researchers measured participants’ cognitive skills and coffee consumption at the same time. This means that the study could not evaluate differences in cognitive decline with age, and reported current coffee drinking may not reflect changes in consumption in previous years. Because it is a cross-sectional study that takes place at one point in time, it cannot establish a cause-and-effect relationship between coffee drinking and cognitive performance. Additionally, the study may not be generalizable to other populations as it included a predominantly white population in Switzerland, where people tend to drink espresso.

“To detect relevant cognitive decline, a follow-up of at least 5-10 years is needed. However, the dietary habits reported by participants, including coffee consumption, reflect exposure over many years and we are likely seeing the results of this here,” says Barbagallo. said.

Study details, background or design:

• The study included 2,413 people (mean age 73; 27% women) with atrial fibrillation who participated in the Swiss Atrial Fibrillation Cohort Study (Swiss-AF) between 2014 and 2017. Swiss-AF is conducted in 14 centers in all language regions in Switzerland.
• Participants had undergone at least eight years of monitoring for stroke, mini-stroke, inflammatory blood markers and blood clotting, brain imaging and repeated cognitive testing. Patients were excluded from the analysis if they had experienced only brief episodes of AFib that resolved without treatment, or if they were unable to provide informed consent.
• At enrollment, participants reported their caffeinated coffee consumption over the past year, with responses summarized as less than one cup per day, one cup per day, two to three cups per day, four to five cups per day, and more than five cups per day. day. Cup size or concentration of caffeine per cup was not quantified. The addition of creams, sugars or flavorings was not taken into account.
• At enrollment, participants completed several cognitive tests that measured verbal skills, executive functioning, memory, processing speed, visual-motor coordination and attention. These were combined into an overall assessment of cognitive skills, the Cognitive Construct (CoCo). Participants also completed a 30-point screening test for cognitive impairment, the Montreal Cognitive Assessment, which measured visuospatial and executive functions, object naming, memory, attention, language and abstraction skills.
• Participants were also assessed for depression using the Geriatric Depression Scale, so researchers could assess whether cognitive performance was likely to be altered by depression.