Consumption of potatoes and incidence rate of coronary artery disease: The Million Veteran Program.

BACKGROUND: Potato consumption is highly prevalent around the world. Previous studies have reported a positive association of potato intake with hypertension and type 2 diabetes. However, data are scarce on potato consumption and risk of coronary artery disease (CAD). OBJECTIVE: We hypothesized that potato consumption is positively associated with the incidence of CAD among US veterans. DESIGN: We prospectively studied 148,671 participants from Million Veteran Program (MVP). We used a semi-quantitative food frequency questionnaire to assess consumption of baked, boiled, and mashed potatoes. The incidence of CAD was assessed through electronic health record. We used Cox Proportional hazard model to compute hazard ratios (HR) and 95% confidence intervals (95% CI) for CAD events across categories of potato intake. RESULT: The average age of participants was 64 years at the time of potato assessment. A total of 6309 new cases of CAD occurred during a mean follow up of 2.7 ± 1.4 y. Median potato consumption was 1 cup/week. The crude incidence of CAD from lowest to highest category of potato consumption was 14.5, 15.0, 15.2, 16.1, and 18.9 per 1000 person-years, respectively. Hazard ratios (95% CI) of CAD were 1.00 (reference), 1.02 (0.93-1.11), 1.02 (0.93-1.12), 1.04 (0.95-1.15), and 1.21 (1.07-1.37) for potato intake of <1 cup/month, 1-3 cups/month, 1 cup/week, 2-4 cups/week, and 5+ cups/week respectively, adjusting for age, gender, race, body mass index (BMI), alcohol consumption, exercise, smoking, DASH (Dietary Approaches to Stop Hypertension) score, and education. The observed relation of potato consumption with CAD was not modified by age, BMI, gender, and ethnicity in a secondary analysis. In a sensitivity analysis, exclusion of CAD events occurred during the first year of follow up did not alter the findings. CONCLUSION: Frequent (5+ cups/week) but not infrequent potato consumption was associated with a higher risk of CAD among MVP participants.

Coffee consumption and risk of heart failure in the Physicians' Health Study.

BACKGROUND: Previous studies have reported the benefits of coffee consumption on diabetes, stroke, hyperlipidemia, and coronary artery disease (CAD). However, no large-scale long-term prospective study has evaluated the relation between coffee consumption and heart failure (HF) among US population. OBJECTIVE: To test the hypothesis that coffee consumption is associated with risk of HF among male physicians. METHODS: We prospectively studied 20,433 middle-aged and older men from the Physicians' Health Study (PHS). Coffee consumption was assessed using a semi-quantitative food frequency questionnaire. The incidence of HF was assessed based on self-reports on annual questionnaires which were validated in a subsample using by review of medical records. We used Cox proportional hazard models to compute the hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). RESULTS: The mean (SD) age of men was 66.4 (9.2) years. During a mean follow-up of 9.3 years, 901 new cases of HF were reported. In a multivariable Cox model adjusting for age, alcohol, smoking, and exercise, the HR (95% CI) of HF were 1.00 (reference), 1.04 (0.84-1.28), 0.90 (0.73-1.11), and 1.09 (0.91-1.30) for coffee consumption of almost never, <1 cup/day, 1 cup/day, and ≥2 cups/day, respectively (P for linear trend - 0.47). In a secondary analysis, dietary caffeine intake was not associated with HF risk: multivariable adjusted HR (95% CI) were 1.00 (reference), 1.07 (0.87-1.31), 0.95 (0.77-1.18), 1.06 (0.86-1.31), and 1.15 (0.92-1.44) across consecutive quintiles of dietary caffeine (P for linear trend - 0.34). CONCLUSIONS: We found no association between either coffee consumption or dietary caffeine intake with HF risk among US male physicians.

Coffee Consumption and Risk of Atrial Fibrillation in the Physicians' Health Study.

Background Although coffee consumption is often reported as a trigger for atrial fibrillation (AF) among patients with paroxysmal AF, prospective studies on the relation of coffee consumption with AF risk have been inconsistent. Hence, we sought to assess the association between coffee consumption and risk of AF in men. Methods and Results We prospectively studied men who participated in the Physicians' Health Study (N=18 960). Coffee consumption was assessed through self-reported food frequency questionnaires. The incidence of AF was assessed through annual questionnaires and validated through review of medical records in a subsample. Cox proportional hazard models were used to calculate hazard ratios and 95% CIs of AF. The average age was 66.1 years. A total of 2098 new cases of AF occurred during a mean follow-up of 9 years. Hazard ratios (95% CI) of AF were 1.0 (reference), 0.85 (0.71-1.02), 1.07 (0.88-1.30), 0.93 (0.74-1.17), 0.85 (0.74-0.98), 0.86 (0.76-0.97), and 0.96 (0.80-1.14) for coffee consumption of rarely/never, ≤1 cup/week, 2 to 4 cups/week, 5 to 6 cups/week, 1 cup/day, 2 to 3 cups/day, and 4+ cups/day, respectively; adjusting for age, smoking, alcohol intake, and exercise (P for nonlinear trend=0.01). In a secondary analysis the multivariable adjusted hazard ratio (95% CI) of AF per standard deviation (149-mg) change in caffeine intake was 0.97 (0.92-1.02). Conclusions Our data suggest a lower risk of AF among men who reported coffee consumption of 1 to 3 cups/day.

Loperamide Induced Life Threatening Ventricular Arrhythmia.

Loperamide is over-the-counter antidiarrheal agent acting on peripherally located µ opioid receptors. It is gaining popularity among drug abusers as opioid substitute. We report a case of a 46-year-old male that was presented after cardiac arrest. After ruling out ischemia, cardiomyopathy, pulmonary embolism, central nervous system pathology, sepsis, and other drug toxicity, we found out that patient was using around 100 mg of Loperamide to control his chronic diarrhea presumably because of irritable bowel syndrome for last five years and consumed up to 200 mg of Loperamide daily for last two days before the cardiac arrest. We hypothesize that the patient's QTc prolongation and subsequent cardiac arrest are due to Loperamide toxicity. Patient experienced gradual resolution of tachyarrhythmia and gradual decrease in QTc interval during hospitalization which supports the evidence of causal relationship between Loperamide overdose and potentially fatal arrhythmias. It also provided the clue that patient may have congenital long QT syndrome which was unmasked by Loperamide causing ventricular arrhythmias. This case adds one more pearl in the literature to support that Loperamide overdose related cardiac toxicity does exist and it raises concerns over Loperamide abuse in the community.