do these drinks increase the risk of stroke?

More and more research is exploring the link between stroke risk and regular consumption of coffee, tea, soda and alcohol. This research roundup reviews the latest findings, highlighting both promising prospects and remaining uncertainties, to guide discussions with your patients.

Coffee and tea: good or bad?

In the study INTERSTROKE high coffee consumption (>4 cups per day) was associated with a significant increase in the risk of all strokes (odds ratio [OR]1.37) or ischemic stroke (OR, 1.31), while low to moderate coffee consumption was not associated with an increased risk of stroke. In contrast, tea consumption was associated with a lower risk of all strokes (OR, 0.81 for highest consumption) or ischemic strokes (OR, 0.81).

In a recent UK Biobank study, drinking coffee or tea was associated with a reduced risk of stroke and dementia, with the greatest benefit associated with drinking both drinks.

Specifically, researchers found that people who drank two to three cups of coffee and two to three cups of tea per day had a 30% decrease in the incidence of stroke and a 28% decrease in the risk of dementia per day. compared to those who did not drink it.

Advice to patients should be that coffee and tea may protect against stroke, but adding sugar should probably be minimized
Dre Cheryl Bushnell

A recent systematic review and dose-response meta-analysis showed that each additional cup of tea per day was associated with an average reduction of 4% in the risk of stroke and 2% in the risk of disease-related events. cardiovascular (CVD).

The protective effect of coffee and tea on stroke risk may be due, in part, to flavonoids, which have antioxidant and anti-inflammatory properties, as well as positive effects on vascular function.

“The advice to patients should be that coffee and tea can protect against stroke, but adding sugar to either drink should probably be minimized,” he told Medscape Medical News the Dre Cheryl Bushnellof Wake Forest University School of Medicine in Winston-Salem, North Carolina, and chair of the American Stroke Association 2024 Guideline for the Primary Prevention of Stroke.

Taylor Wallacedoctor of food sciences, declared to Medscape Medical News that “most people should consume one or two cups of unsweetened tea per day, in moderation, for cardiometabolic health.” It’s an easy step toward good health, but not a panacea.”

When it comes to coffee, adults who like it should drink it “in moderation — just cut out the cream and the sugar,” said Taylor Wallace, an associate professor at George Washington University, Washington, D.C., and Tufts University, Boston, Massachusetts.

“One or two cups of black coffee with skim or non-skim milk for breakfast is a healthy way to start the day,” says the researcher.

The basics about sodas

When it comes to sugary and diet drinks, data from the Nurses’ Health Study and the Health Professionals Follow-Up Study showed a 16% increase in stroke risk with one or more daily servings of sugary drinks or hypocalories per day (versus none), independently of dietary and non-dietary cardiovascular risk factors.

In the observational study Women’s Health Initiative conducted among postmenopausal women, higher consumption of artificially sweetened beverages (with artificial sweeteners) was associated with an increased risk of all strokes (adjusted hazard ratio [RRA]1.23), ischemic stroke (ARR, 1.31), coronary heart disease (ARR, 1.29), and all-cause mortality (ARR, 1.16).

In the cohort Framingham Heart Study Offspring drinking one or more cans of diet soda per day (versus none) was associated with an almost three times higher risk of stroke and dementia over a 10-year follow-up period.

Another French study showed that total consumption of artificial sweeteners from all sources was associated with an increased overall risk of cardiovascular and cerebrovascular diseases.

However, given the limitations of these studies, it is difficult to draw definitive conclusions, warned Taylor Wallace.

“We know that drinks sweetened with artificial sweeteners are linked to weight gain and promote cardiometabolic dysfunction in children and adults,” he said.

However, “there is not really convincing evidence that diet sodas have an impact on human health. Most observational studies are mixed and likely greatly confounded by other dietary and lifestyle factors. This does not mean that we should exaggerate; One diet soda a day is probably OK, but that doesn’t mean you should drink 10 a day,” he added.

Alcohol: moderation or abstinence?

Data on alcohol consumption and stroke risk have varied over the years. For decades, data suggested that moderate alcohol consumption per day (one to two drinks in men and one drink in women) could be beneficial in reducing major vascular consequences.

However, in recent years, research has not shown the benefits of moderate alcohol consumption. However, the harmful effects of excessive alcohol consumption are clear.

Regardless of stroke risk, the strongest evidence shows that all alcohol consumption is associated with worse cognitive function
Cheryl Bushnell

A large meta-analysis showed that light to moderate alcohol consumption (up to one drink per day) was associated with a reduced risk of ischemic stroke. On the other hand, excessive alcohol consumption (more than two drinks per day) significantly increases the risk of ischemic and hemorrhagic stroke.

A separate study showed that young adults who drink alcohol moderately or excessively are at increased risk of stroke and that this risk increases with the number of years of drinking.

In the INTERSTROKE study, high to moderate alcohol consumption was associated with an increased risk of stroke, while low alcohol consumption did not result in an increased risk.

However, Cheryl Bushnell stressed that the study data was based on self-reporting and that other healthy behaviors could offset the risk from alcohol consumption.

“Regarding alcohol, regardless of stroke risk, the strongest evidence shows that any alcohol consumption is associated with worse cognitive function, so that in general, more alcohol consumption “The lower the alcohol, the better,” Ms. Bushnell said.

She notes that currently, the American Heart Association (AHA) and the American Stroke Association (ASA) recommend a maximum of two drinks per day for men and one drink per day for women to reduce the risk of ‘stroke.

“However, the data regarding the risk of cognitive impairment associated with alcohol use is compelling and should be considered in addition to the AHA/ASA recommended maximum alcohol intake,” said Dr. Bushnell.

“We know that excessive alcohol consumption puts people at significant risk of cardiovascular disease, cancer, cognitive decline and a whole host of other health problems – there’s no doubt about that,” said Taylor Wallace.

The impact of moderate consumption, however, is less clear. “Alcohol is a highly biased and political issue, and the evidence (or lack thereof) on both sides is poor at best,” the researcher added.

A key challenge is that it is difficult even for scientists to accurately assess alcohol consumption and most studies rely on self-reported data from observational cohorts. . These often include limited dietary assessments, which provide only a partial picture of long-term drinking habits, Taylor Wallace noted.

“In short, we don’t know whether moderation is beneficial, detrimental or null for health,” he said.

This article was translated from Medscape.com using several editorial tools, including AI, in the process. The content was reviewed by the editorial staff before publication and completed by Stéphanie Lavaud.