Coffee and stroke

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The World Heart Federation states that every year 15 million people worldwide suffer a stroke. Nearly six million die and another five million are left permanently disabled. Stroke is the second leading cause of disability after dementia. Globally, stroke is the second leading cause of death above the age of 60 years, and the fifth leading cause of death in people aged 15 to 59 years old70.

In many developed countries the incidence of stroke is declining even though the actual number of strokes is increasing because of the aging population.  In the developing world, however, the incidence of stroke is increasing.

Research shows that moderate coffee consumption may reduce the risk of stroke, and limit the deleterious consequences of suffering a stroke.

A prospective study of 26,556 male Finnish smokers reported that the relative risk of developing a non-hemorrhagic stroke was significantly reduced by 12% with the consumption of 4-5 cups of coffee per day. The risk was reduced further to 23% in the heaviest consumers (≥ six cups per day) compared to those who drank less than 2 cups per day. However, coffee consumption did not protect against intra-cerebral or subarachnoid hemorrhage71.

This association was extended to women in a study where 34,670 women were followed up prospectively. Coffee consumption (2-5 cups per day) was associated with a significant 22-25% risk reduction of total stroke, cerebral infarction, and subarachnoid hemorrhage but not intra-cerebral hemorrhage72.

The prospective Nurses’ Health Study of 83,076 women also reported a 20% reduced risk of stroke with the consumption of 2-4 cups coffee per day, compared to one cup per month. The association was stronger among never and past smokers, with a risk reduction of 43% with 4 cups a day. Other drinks containing caffeine, such as tea and caffeinated soft drinks, were not associated with stroke73.

A 2011 meta-analysis including eleven prospective studies, with 10,003 cases of stroke among 479,689 participants, found that moderate coffee consumption may be weakly, non-linearly, inversely associated with risk of stroke74.

In a further study, 10 patients who suffered a cortical stroke were given a caffeinol mixture injection (approximately eight to nine  mg/kg caffeine – the equivalent of 5-7 cups of coffee – with 0.3-0.4 g/kg ethanol, or two doses of strong alcohol), and fibrinolysis with tissular plasminogen activator (t-PA ), in the 134 min following the first clinical signs. The efficacy of the cocktail was optimal when administered during the first 95 minutes. Among the 10 patients treated with caffeinol, six had preserved activities and autonomy, while this was only the case in 26% of the 90 patients treated in a classical manner75. The mechanisms of action underlying these effects could involve the inhibition of adenosine receptors by caffeine, and the receptors of the main inhibitory neurotransmitter, GABA, by ethanol but await further validation.

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