VOLUME 31

NUMBER 1
SEPTEMBER 2020

Coffee: A heart-healthy brew? INSIDE

Ask the Doctor��������������������2
Here’s the scoop on how coffee may affect your heart—and the best Sleep apnea and the heart

way to prepare and enjoy this aromatic beverage. Tennis, anyone?������������������3

Blood pressure advice��������4

M any people enjoy cof-

fee, not just for the taste
but for the stimulating jolt of
professor of nutrition and
epidemiology at the Harvard
T.H. Chan School of Public
A hole inside the heart�������5
Trials and tribulations
caffeine each cup delivers. But Health. The compounds, caf- of research�������������������������  6
© adamkaz | Getty Images

this dark, bitter brew actually estol and kahweol, are pres- Seed of the month�������������  7
contains more than 1,000 dif- ent either as oily droplets or News briefs ������������������������8
ferent chemical compounds, in the grounds floating in the ϐϐBlood pressure drugs in old age
some of which seem to have coffee. Using a paper or cloth ϐϐClot-prevention drug update
ϐϐChronic pain and heart risk
favorable effects on factors filter traps and removes these
linked to heart disease. What’s compounds. However, many NEW ONLINE COURSE FROM
more, several recent popula- home coffeemakers sold in HARVARD HEALTH PUBLISHING
tion-based studies have linked the United States come with Improving Your Memory:
coffee drinking to longevity— Compounds found in coffee have reusable gold or nylon filters. Tools and strategies for protecting,
a range of heart-related effects. preserving, and boosting your
specifically, to a lower risk of It’s not clear whether these memory as you age
dying of heart disease. types of filters remove cafestol or kahweol, www.health.harvard.edu/mem
The largest one to date, published earlier but Dr. Willett suspects they may not, as the
this year, took a closer look at how differ- holes in metal and nylon filters are larger than FIVE THINGS TO
French Press © microgen | Getty Images; Espresso © efired | Getty Images

ent brewing methods might influence cof- those in cloth and paper. DO THIS MONTH
fee’s effect on the heart. Filtered coffee seems Still, if you prefer unfiltered coffee, drink-
to be the best option, according to the study ing a cup or two a day shouldn’t be a prob-
authors (see “Brewing controversy: Filtered lem, says Dr. Willett. “But if you typically
1 Enjoy a few cups of coffee
daily, if you like it. The
aromatic brew may help prevent
vs. unfiltered coffee” on page 7). drink more than that, it could raise your heart disease. But filtered coffee
“Unfiltered coffee, such as French press LDL and modestly increase your risk of heart seems to be better than unfiltered.
(page 1)
coffee and espresso, contains compounds disease,” he adds. (LDL is the “bad” form
that tend to increase the harmful type of of cholesterol.)
cholesterol,” explains Dr. Walter Willett, continued on p. 7 ▶▶ 2 Take the STOPBANG quiz.
Find out if you should be
tested for sleep apnea, which can
contribute to cardiovascular risk.
Types of unfiltered coffee (page 2)
Some coffee aficionados prefer unfiltered brew, which
can be prepared several ways. One involves mixing boil-
ing water and coarsely ground coffee beans in a small
3 Swing a racquet for fitness.
Playing tennis and other
racquet sports is linked to a lower
pitcher called a French press, letting it steep for a few risk of heart disease. (page 3)

4
minutes, and then pressing a mesh plunger from the top Be vigilant about controlling
of the pitcher to the bottom to strain the liquid and trap your blood pressure. It may
the coffee grounds. Espresso, which is made by forcing French press Espresso help preserve your thinking skills
hot water through superfine coffee grounds using an espresso maker, is another popular example. as you age. (page 4)
Both preparation methods leave more of the potentially cholesterol-raising compounds (see main
story) in your cup than filtered coffee. However, the levels in espresso tend to be lower than in 5 Try tahini. It’s made from
ground sesame seeds,
which are rich in healthy
French press coffee, and people also tend to drink smaller amounts of espresso.
unsaturated fats. (page 7)
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Editor in Chief Deepak L. Bhatt, MD, MPH
Executive Editor Julie Corliss
Editorial Board
Board members are associated with Harvard Medical School
and affiliated institutions.
Heart Peter Zimetbaum, MD
Bone Disease Scott Martin, MD, Donald T. Reilly, MD, PhD
Cancer Marc Garnick, MD
Dermatology Kenneth Arndt, MD, Suzanne Olbricht, MD
Endocrinology Alan Malabanan, MD
Exercise/Lifestyle I-Min Lee, MD, ScD, JoAnn E. Manson, MD, DrPH
Gastroenterology Jacqueline Lee Wolf, MD
Geriatrics Suzanne E. Salamon, MD
Neurology Gad Marshall, MD
Nutrition Eric B. Rimm, ScD
Psychiatry Ann R. Epstein, MD, Michael Miller, MD,
Ronald Schouten, MD, JD
Urology William C. DeWolf, MD
Women’s Health Karen Carlson, MD, Martha K. Richardson, MD,
Isaac Schiff, MD
• blood pressure. Repeated surges in blood pressure levels can damage the lining
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ASK THE DOCTOR
by DEEPAK L. BHATT, M.D., M.P.H., Editor in Chief
How does sleep apnea affect the heart?
Q My husband is reluctant to get tested for sleep apnea.
But I’m pretty sure that he has it, and I’m concerned
because I’ve heard that it can contribute to heart disease.
How are these two conditions connected?
A As you likely know already, people with sleep apnea
may snore loudly and may also periodically gasp for
breath throughout the night. These explosive snorts of-
ten wake up bed partners or roommates—although not
necessarily the person with apnea.
Obstructive sleep apnea (as the condition is officially
called) occurs when tissue in the tongue or the throat temporarily obstructs the
airway during sleep, sometimes as many as 30 times per hour. The condition affects
people of all ages and sizes, but it is most common in men over 40 who are over-
weight or obese. And you are correct: it is closely linked to cardiovascular disease.
Here’s why: Each time a person with sleep apnea stops breathing, the body’s
oxygen level drops. The body reacts by producing epinephrine (also called adrena-
line), a stress hormone. Over time, high adrenaline levels can contribute to high
of the blood vessels, and sleep disturbances can also raise levels of harmful LDL
cholesterol and other blood fats. These changes may lead to clogged arteries and
poor heart muscle function. People with untreated sleep apnea are twice as likely
to have a heart attack compared with
Sleep apnea test: STOPBANG those who don’t have the disorder.
A “yes” answer to three or more of these questions One way doctors assess the like-
suggests possible sleep apnea. Ask your doctor if you lihood of sleep apnea is a with the
should have a sleep study. STOPBANG test, at left. But a defini-
S Snore: Have you been told that you snore? tive diagnosis requires a sleep study.
If your husband is worried about
T Tired: Do you often feel tired during the day? spending the night in a sleep labora-
Obstruction: Do you know if you briefly tory, reassure him that most of the
O stop breathing while asleep, or has anyone time, that’s not necessary. Instead, a
witnessed you do this?
doctor can prescribe a home-based
Pressure: Do you have high blood pressure or
P take medication for high blood pressure?
test, using equipment you borrow
from a sleep lab. This includes a
Body mass index (BMI): Is your BMI 30
small, lightweight monitor and sev-
B or above? (For a calculator, see eral sensors that measure oxygen
www.health.harvard.edu/bmi.)
A Age: Are you 50 or older? movements during sleep. Today,
Is your neck circumference more than
N 16Neck:
inches (women) or 17 inches (men)?
about 60% to 70% of sleep studies
for suspected sleep apnea are done
G Gender: Are you male? using home-based tests. If his symp-
toms suggest moderate to severe
sleep apnea and he has no other serious medical problems, a home-based test is
almost as accurate for detecting apnea as a test done in a sleep lab.
Send us a question for Ask the Doctor
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Available online at https://www.health.harvard.edu/listen answer every question, nor can we provide personal medical advice.
2 | Harvard Heart Letter | September 2020 www.health.harvard.edu
 Racquet sports: A good way to ramp parks and recreation department or
community center for classes.
up your fitness
Pickleball
From badminton to pickleball to tennis, hitting objects If you want a slightly slower-paced
across a net can be a fun, effective way to get in shape. game, check out pickleball, one of the
fastest-growing sports

L ooking for an exercise

that gets your heart
pumping and strength-
Pickleball, a low-key version of tennis, can be a
fun way to get fit and socialize at a distance.
among older adults. This
hybrid sport is a mix of ten-
nis, table tennis, and bad-
© BHPix | Getty Images

ens muscles in your legs, minton. The lightweight

arms, and core? Tennis paddles are a bit bigger
and other racquet sports than those used to play
can serve up all those Ping-Pong, and the plastic
benefits and more. In pickleball travels at about
fact, several long-run- one-third the speed of a
ning studies have linked tennis ball, making it easier
racquet sports to a lower Racquet sports Activity METs
to see and hit. The game is
risk of cardiovascular dis- vs. running: Brisk walking (3 miles/hour) 4.0 played both indoors and
ease and a longer life. How much effort? Running (6 miles/hour) 9.8 outdoors, on a small court
“Playing tennis is To gauge exertion, exercise Racquet sport activities (20 feet by 44 feet, about the
amazing workout. And no researchers often use a Table tennis (Ping-Pong) 4.0 size of a badminton court),
matter how good you are, standard measure known and the net is shorter than
Pickleball 4.1
you can have fun doing as a metabolic equivalent, a tennis net. As with ten-
it,” says Joe DiVincenzo, a or MET. It’s based on how Tennis, doubles 4.5–6.0 nis, you can play singles
physical therapist at Har- much oxygen the average Badminton 5.5 or doubles, and the close
vard-affiliated Spaulding person uses during a Racquetball 7.0 proximity to other players
Rehabilitation Hospital particular activity: A single means it’s a good way to
Squash 7.3
and former competitive MET is the amount of socialize while exercising.
energy you expend when Tennis, singles 7.0–8.0
tennis player. In general, Pickleball has become a
you’re sitting quietly. Source: Compendium of Physical Activities, 2011.
racquet sports engage staple at many YMCAs and
Activities rated at 2 METs use twice as much oxygen as sitting,
muscles throughout your 3 METs means three times as much oxygen, and so on.
senior community cen-
upper and lower body, ters. You can find places to
which challenges your Even the easiest racquet sport—table tennis—requires as much ­effort play at the website of the
heart. During a match, as brisk walking. Singles tennis is more vigorous and depends on USA Pickleball Association
you do frequent, short your skill level; professional players likely reach levels above 8 METs. (www.usapa.org).
bursts of high-intensity
activity interspersed with less vigor- tennis is that you can keep playing well Low-impact racquet sports
ous movements—a perfect example of into your later years. “What older play- Two lower-key racquet sports, table ten-
interval training. Also known as HIIT ers lose in mobility, they often make up nis (Ping-Pong) and badminton, may be
(high-intensity interval training), this for with skill from years of practice, and more accessible to the average person.
workout strategy seems to be a good that’s what keeps them competitive,” You might even be able to play at home,
way to boost cardio­vascular fitness. he adds. provided you have the space. Ping-Pong
If you’re a beginner, it’s best if you tables take up a lot of room, but you can
Tennis can take a few lessons. You don’t need to buy a small retractable net, paddles, and
Playing tennis burns about twice as spend a lot on your first racquet, but it balls to play on your own table. If bad-
much energy per hour as brisk walking helps to invest in lots of balls and a ball minton is more your speed, you don’t
(see “Racquet sports vs. running: How hopper, a portable wire basket for pick- necessarily need a net—just a couple of
much effort?”). And if you play with a ing up balls, advises DiVincenzo. racquets, a birdie, some open outdoor
partner who’s evenly matched, it’s easy There’s no need to join a tennis club; space, and a partner. The important
to spend several hours on the court, says many communities have neighborhood thing is finding a fun way to be active,
DiVincenzo. The other nice thing about tennis courts. Check with your local no matter what your level of fitness.
www.health.harvard.edu September 2020 | Harvard Heart Letter |3
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Lowering blood pressure damage can accumulate, leading to
problems with thinking.
may help prevent dementia The damage is visible on MRI
scans as bright spots called white
High blood pressure can damage the brain in matter lesions (white matter con-
several ways. Treating this common problem

© Nik01ay | Getty Images

sists of bundles of nerve fibers
can protect your mind as well as your heart. that connect brain cells). Nearly
everyone over age 60 has these

H igh blood pressure seldom causes High blood pressure’s

any symptoms. But over time, the harms
excessive force and friction of blood High blood pressure can damage both
lesions, which may contribute
to normal, age-related memory
loss. But people with high blood
pushing against the inner walls of the large and small blood vessels of pressure have more extensive white
the arteries can damage blood vessels the brain, probably in slightly different matter damage.
throughout the body. And while the ways, explains Dr. Greenberg. High
biggest threat may be to your heart, blood pressure accelerates the pro- An evolving view of dementia
your brain can also suffer. cess of atherosclerosis, the buildup of Our understanding of dementia has
Even slightly elevated blood pressure fatty plaque inside artery walls, which evolved over the past decade. Experts
in middle age has been linked to a 30% leaves you prone to an ischemic stroke. now recognize that many people who
higher risk of dementia two decades These strokes occur when a blood clot lose their memory with age have more
later. But taking blood pres- than one type of dementia,
sure drugs may help people Blood pressure categories including Alzheimer’s dis-
avoid that risk, according SYSTOLIC DIASTOLIC ease, vascular dementia,
BLOOD PRESSURE CATEGORY
to a study in the May 19, (upper number) (lower number) and other, less common
2020, issue of JAMA. Normal Less than 120 mm Hg and Less than 80 mm Hg forms. “While we’re still
The study included waiting for a breakthrough
Elevated 120–129 mm Hg and Less than 80 mm Hg
findings from 12 stud- for Alzheimer’s prevention,
ies involving more than High blood pressure: Stage 1 130–139 mm Hg or 80–89 mm Hg it’s good to know we have
hypertension
92,000 people. Their aver- common medications at
age systolic blood pressure High blood pressure: Stage 2
hypertension
140 mm Hg or higher or 90 mm Hg or higher hand that can help prevent
(the first number in a blood dementia,” says Dr. Green-
Hypertensive crisis (consult and/ Higher than
pressure reading) was your doctor immediately) Higher than 180 mm Hg
or 120 mm Hg berg. The fact that the
154 mm Hg; their average Source: American Heart Association and American Stroke Association. study showed measurable
diastolic reading (the sec- benefits from taking blood
ond number) was 83 mm Hg. After a blocks an artery in the brain. If an pressure drugs over just four years is
follow-up period (about four years on ischemic stroke affects an area of the especially encouraging, he adds.
average), the risk of dementia or cog- brain important for cognition, it can What’s more, the results line up with
nitive impairment was about 7% lower contribute to a condition called vas- findings from a 2016 study in The New
among people who took blood pressure cular dementia. But increasingly, evi- England Journal of Medicine showing
drugs compared with those who didn’t. dence suggests that vascular dementia that the age-adjusted rates of dementia
“This study underscores the think- often stems from damage to the brain’s have been slowly dropping over time.
ing that lowering blood pressure is smaller vessels. The disease is also showing up later in
likely to be an effective way to prevent High blood pressure causes the walls life: the average age of a dementia diag-
cognitive impairment,” says Dr. Ste- of the smaller arteries in the brain to nosis went from 80 to 85 over the past
ven Greenberg, professor of neurol- thicken, setting the stage not just for 30 years. One possible explanation:
ogy at Harvard Medical School. People ischemic strokes, but also hemorrhagic the increased focus on treating high
with cognitive impairment struggle to strokes. Also called bleeding strokes, blood pressure and other heart-related
remember and learn new things and hemorrhagic strokes happen when a risks that occurred over that same time
have trouble with concentration and brain blood vessel leaks or ruptures. period, says Dr. Greenberg. Bottom
decision making. The condition is often Minor strokes stemming from line: If your blood pressure is higher
a forerunner to dementia, which refers damage to these smaller vessels may than normal (see “Blood pressure cat-
to more serious memory and thinking go unnoticed. But if people experi- egories”), treatment will likely benefit
problems that affect everyday living. ence many small, “silent” strokes, the your brain as well as your heart.
4 | Harvard Heart Letter | September 2020 www.health.harvard.edu
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 New advice about a common heart for people younger than 60 who expe-
rience a stroke with no other obvious
variation: Patent foramen ovale (PFO) cause. “This update is a step in the right
direction, but we still have a lot to learn
Researchers are beginning to better understand if, when, about PFOs,” says Dr. Ning. This will
and how to address this condition, which is linked to a require collaboration between cardiol-
newly recognized type of stroke. ogists, neurologists, hematologists, and
primary care providers, she adds.

I n the womb, all fetuses have a foramen (historically designated “cryptogenic,” She and colleagues suspect that by
ovale (Latin for “oval hole”) between meaning hidden) seem to occur with- allowing “dirty” blood from the veins to
© rabbitteam | Getty Images

the heart’s right and left upper cham- out any obvious explanation. Many avoid being filtered by the lungs, a PFO
bers (atria). This opening allows blood stroke experts now say that about half may encourage clots to form through-
to take a shortcut within the heart rather of such strokes should be reclassified as out the body, as well as letting them
than following a longer path through the “PFO-associated strokes.” through to the brain. “I think of the
lungs, which cannot work until lungs as silent heroes, because
they are exposed to air. After Right Left
they trap and filter clot-activat-
birth, when a newborn baby atrium atrium ing debris, such as homocyste-
takes his or her first breath, the ine, in the blood,” she says. If
foramen ovale begins to close. a person with a PFO has other
Most of the time, it seals com- factors that increase clot forma-
pletely within a few months. tion, it’s like a one-two punch.
But in about a quarter of peo- These other factors include
ple, that doesn’t happen. This uncommon genetic conditions
anatomical variation is called Patent foramen ovale
such as protein C/S deficiency,
a patent foramen ovale (pat- factor V Leiden, and others.
ent means open) or PFO. Most Additional conditions that
people never know they have it, About one in four people raise clot risk include obesity,
has a patent foramen
because a PFO doesn’t cause any ovale, a flaplike opening sleep apnea, and pregnancy; so
signs or symptoms. For the most between the heart’s does long-distance travel and
part, the condition is harmless. right and left atria. other situations that involve
But in people with a PFO, long periods of immobility. For
venous blood can leak (or “shunt”) Establishing this new cause for people in those situations, extra pre-
across the heart from the right atrium strokes is important to better predict cautions (including treatment, when
to the left atrium (see illustration). and prevent them, Dr. Ning says. “It’s possible) are crucial to help prevent
“Clots from veins can travel through frustrating for me, but it’s devastating strokes, says Dr. Ning.
this ‘back door’ and go on to the brain, for my patients, because we only look Ideally, future discoveries will help
causing strokes,” says neurologist Dr. for and find a PFO after a stroke hap- pinpoint those people who might ben-
MingMing Ning, a PFO specialist who pens,” she says. efit from PFO closure, anti-clotting
co-directs the Cardio-Neurology Divi- medications, or both. To that end, Dr.
sion at Harvard-affiliated Massachusetts Plugging the PFO Ning is carrying out a study that relies
General Hospital. This is not uncom- For many years, the evidence about on proteomics—which involves check-
mon and may account for as many as whether to repair the PFO to prevent ing blood for unique “fingerprints”—to
one in 10 strokes. future strokes in these patients was predict PFO risk and monitor treat-
inconclusive. But in 2017, three mul- ment. Currently, a PFO-associated
Different causes for strokes ticenter trials found that a minimally stroke is a diagnosis of exclusion,
Most ischemic strokes (those caused by invasive procedure to close a PFO low- meaning it is only diagnosed when
a clot that blocks a vessel in or lead- ers the likelihood of another stroke bet- other obvious causes of stroke have
ing to the brain) occur in people who ter than drug therapy. been ruled out. “But I hope that PFO
have high blood pressure, diabetes, and Earlier this year, the American Acad- will eventually be included with other
other known causes that put them at emy of Neurology updated its advice traditional risk factors for stroke, mak-
risk for both heart attacks and strokes. on the matter, suggesting that clini- ing it a diagnosis of inclusion rather
However, about 20% to 30% of strokes cians may recommend PFO closure than exclusion,” she says.
www.health.harvard.edu September 2020 | Harvard Heart Letter |5
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How do doctors evaluate treatments
for heart disease?
Studies of drugs, diets, and devices
all come with their own
unique set of challenges.
T he best way to know if a new
medical treatment truly
works is with a randomized con-
trolled trial—the “gold standard” of
research studies, also known simply as
a clinical trial. Volunteers are randomly
assigned to receive either the new treat-
ment or the comparison, which may
be a placebo (an inactive therapy) or a
treatment that’s already available.
As the nation’s top cause of death,
cardiovascular disease has been at the
leading edge of evidence generation,
says Dr. Robert Yeh, director of the
Smith Center for Outcomes Research
in Cardiology at Harvard-affiliated Beth
Israel Deaconess Medical Center. “We
probably have more evidence for cardio-
vascular treatments than for any other
field of medicine,” he says. Among the
studies with the greatest impact were the
clinical trials that heralded new thera-
pies to treat heart attacks. These include
clot-dissolving drugs in the 1980s, fol-
lowed in the 1990s by artery-opening
angioplasty procedures, which remain
the standard of care today. Stents, the
tiny mesh tubes used in these pro-
cedures, have also been extensively
studied in clinical trials (see “Testing
devices: Different dilemmas”).
The price of success?
The use of medications after a heart
attack is also based on findings from
clinical trials. These include low-dose
aspirin, cholesterol-lowering statins,
and blood pressure drugs. Because of the
strength of the evidence, physicians feel
very confident about these drugs’ ben-
efits. In fact, these treatments have cut
the risk of a repeat heart attack in half.
However, future trials of new thera-
pies to further lower that risk must
6 | Harvard Heart Letter | September 2020 www.health.harvard.edu
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Testing devices:
Different dilemmas
Devices used to treat heart prob-
lems include stents, pacemakers,
artificial heart valves, and more.
While some argue that new devices
should be compared against a sham
(inactive) device or procedure, that
raises ethical issues related to the
potential risks to people receiving
the sham. In some cases, devices
can be pitted against drug therapy.
Just like computers, however, devices
are constantly being updated and
improved, so by the time the trial is
completed, the device may be on its
third iteration. And over time, doctors
also improve their skills for deploying
new devices, another factor that can
affect the success of the device.
include many thousands of partici-
pants to show even a modest improve-
ment over the best available treatments.
These big trials are very costly, which
means that even major drug companies
are moving away from developing and
testing new cardiovascular medica-
tions, says Dr. Yeh.
Clues, not causes
In contrast, when it comes to the life-
style advice doctors offer about pre-
venting heart disease or slowing its
progression, the evidence isn’t quite
as definitive. Much of it comes from
observational studies, which follow
a large group of people over a long
period of time. Through questionnaires
or interviews, researchers gather infor-
mation on a wide range of possible
influences—diet, exercise, and medical
and family history, for example.
© Brandon Laufenberg | Getty Images
Although findings from these stud-
ies provide clues to habits—both good
and bad—that affect the heart,
they can’t prove cause and effect.
Researchers attempt to control for
confounding variables that might
affect the results (age, race, sex, and
socioeconomic status, to name a few),
but that’s not foolproof, Dr. Yeh says.
For example, observational studies
suggested that taking hormone therapy
(estrogen and progestins) appeared
to lower the risk of heart disease in
perimenopausal and postmenopausal
women. But in the late 1990s, clinical
trials showed a complete reversal of that
assumption: hormone therapy actually
increased the risk of heart disease.
Still, clinical trials are not always
practical—or even ethical. For instance,
a trial of cigarette smoking is unthink-
able. Diet and nutrition research is
especially tricky. In observational stud-
ies, people may not remember what or
how much they actually ate. And diet
is influenced not just by socioeconomic
factors but also education and culture,
which may themselves affect heart
­disease risk, says Dr. Yeh.
Getting people to stick to a specific
diet for years is difficult. Still, several
long-term clinical trials suggest that a
Mediterranean diet is more effective
than a reduced-fat diet for preventing
heart attacks and related problems.
Despite their limitations, observa-
tional studies are generally easier to
conduct than clinical trials. Scientists
can tap growing amounts of health-
related data, from electronic medical
records as well as wearable devices that
record the heart’s rate and rhythm, for
example. The availability of all these
data—coupled with today’s enhanced
computing power—means that doing
observational research may be simpler
and more efficient than in the past,
says Dr. Yeh.
 Coffee and the heart … from p. 1
The perks of polyphenols
What about the other compounds
found in coffee? In addition to small
© chorboon_photo | Getty Images
suggests that over the long term, coffee Seed of the month
drinking may nudge up blood pressure.
However, people have a wide range of
responses to caffeine. Some people are
particularly sensitive and develop a

amounts of magnesium, potassium, pounding or irregular heartbeat after

and niacin, coffee beans are loaded with
potent anti-inflammatory substances
known as polyphenols. Together, these
substances may delay the absorption
of blood sugar, help cells draw sugar
from the blood, and help blood ves-
sels contract and relax. Those actions
could explain why coffee is associated
with a slower rate of weight gain with
age and a lower risk of diabetes, as well
as a reduced risk of dying from cardio-
vascular disease. “Decaffeinated coffee
appears to have similar benefits, which
suggests the effects are unrelated to
­caffeine,” says Dr. Willett.
The effects of caffeine aren’t quite as
positive. Over time, caffeine may slightly
boost metabolism, which may help peo-
ple control their weight. But caffeine can
trigger a short-term rise in blood pres-
sure and heart rate, and some evidence
Brewing controversy:
© Farknot_Architect | Getty Images
even a single cup of coffee.
Several studies suggest that drink-
ing coffee doesn’t seem to make people
more prone to develop atrial fibrilla-
tion, an irregular, rapid heart rhythm.
But if you already have this condition
(which can cause dizziness and raises
stroke risk), pay close attention to
whether caffeine triggers your symp-
toms. If it does, avoid or cut back on
coffee—or switch to decaf.
Finally, remember to be mindful
about the fat and calories you may be
adding to your coffee in the form of
half-and-half and sugar—but especially
the whipped cream and sugary syr-
ups that are popular as add-ins for the
jumbo-sized coffee concoctions sold in
coffee shops. These can add a lot of satu-
rated fat and empty calories to your diet,
crowding out more healthful foods.
Sesame seeds
Sesame seeds may be most familiar
as a topping on bagels, burger buns,
and breadsticks. The tiny, tear-shaped
seeds have a nutty, slightly sweet
flavor that’s enhanced when they’re
baked or lightly toasted in a skillet.
Most are off-white or tan, but you can
also find black varieties, which are
popular in Asian cuisine.
Sesame seeds contain lignans and
phytosterols, plant compounds that
may have cholesterol-lowering effects.
They’re also a decent source of cal-
cium and magnesium, two minerals
linked to better blood pressure control.
Like other seeds, sesame seeds are
rich in healthy unsaturated fats. You

can use untoasted, light-colored

Filtered vs. unfiltered coffee
Norwegian researchers wondered if the brewing
method of one of the world’s most popular beverages
had any effect on mortality—in particular, deaths from
heart disease. So they carried out a large observa-
tional study, which was published online April 22, 2020,
by the European Journal of Preventive Cardiology.
Here’s summary of the study and the results.
Who: A representative sample of Key findings: Drinking filtered coffee was
508,747 healthy Norwegian men and linked to a 15% lower risk of dying pre-
women ages 20 to 79. maturely from any cause, compared with
people who drank no coffee. For cardio­
When: Participants were enrolled
vascular disease, filtered coffee was linked
between 1985 and 2003 and followed
© jreika | Getty Images
sesame oil for cooking and stir-frying.
Toasted sesame oil, which is a dark
brown color, is best used in dressings
or sauces or drizzled over vegetables,
noodles, or other dishes.
Tahini—which consists of sesame
seeds ground into a paste—is a key
ingredient in hummus. You can also
blend two parts tahini with one part
water (plus a little salt and garlic
powder) for an easy dip or dressing.

to a 12% lower risk of death for men and

for an average of 20 years.
How: Researchers recorded the type
and amount of coffee the participants
drank when they joined the study, along
with other relevant variables such as
whether they smoked, their exercise
habits, weight, blood pressure, and
cholesterol levels.
a 20% lower risk of death for women com-
pared with no coffee. Over all, unfiltered
coffee was also associated with a slightly
lower mortality (4% and 9% in men and
women, respectively) compared with no
coffee. But among men over 60, unfiltered
coffee was linked to a slightly higher risk of
death from cardio­vascular disease.

www.health.harvard.edu September 2020 | Harvard Heart Letter |7

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 RESEARCH WE’RE WATCHING

Blood pressure drugs may extend life even for frail, older people
F rail, older people with health problems may
live longer if they take the blood pressure
in 2011 and 2012. Over the
next seven years, researchers

© RapidEye | Getty Images

medications their doctors prescribe, according to
a study published in the August 2020 issue of the
journal Hypertension.
Previous research suggests that in general, older
people benefit from blood pressure drugs. But trials
usually don’t include people with multiple medical
conditions, because those health problems make
longevity findings challenging to interpret.
The new study relied on data from nearly 1.3
million people ages 65 and older who had three or
more prescriptions for blood pressure medication
tracked the percentage of
people who continued taking
the medications.
Compared with people
who didn’t take their blood pressure drugs regularly
(less than 25% of the time), those who took their
pills more than 75% of the time were less likely to
die during the study. Those who started in good
health were 44% less likely to die, but even those
who were in poor health saw a benefit: they were
33% less likely to die.

FDA approves broader use of clot-prevention drug

T icagrelor (Brilinta), a drug that helps prevent
blood clots, was approved in 2011 for treating
people who had experienced a heart attack or acute
coronary syndrome (a sudden loss of blood flow
to the heart). Now, the drug can be prescribed to
a broader group of people. In June 2020, the FDA
expanded ticagrelor’s approval to reduce the like-
lihood of first heart attack or stroke among high-
risk people with coronary artery disease.
The expansion is based on results from a
multiyear study of more than 19,000 people with
coronary artery disease and diabetes at high risk
for a heart attack. Participants who took aspirin
plus ticagrelor were less likely to experience a
heart attack, stroke, or death from heart disease
compared with those who took aspirin alone.
Ticagrelor prevents tiny particles in the blood
called platelets from clumping together to form
blood clots. Like similar drugs, it can increase
the risk of serious bleeding, including in the
gastrointestinal tract and brain. But for many
people with severe coronary artery disease but no
risk factors for bleeding complications, the benefits
may outweigh the risks.

Chronic pain linked to higher risk of heart attack and stroke

P eople with chronic pain may be more likely to
have a heart attack or stroke than those with-
out chronic pain, according to a study published
online May 7, 2020, by the
journal Pain Medicine.
From 2001 to 2005,
both over-the-counter drugs and prescription
opioids. For the comparison group, researchers
used 35,228 people without chronic pain who were
matched by age and sex to those in the first group. .
During the follow-up, which lasted until 2015,
people with chronic pain were 20% more likely

© PeopleImages | Getty Images

researchers identified 17,614
Taiwanese people who had
used pain relievers for at
least three months. The
most common causes of
pain were spinal disorders,
arthritis, and headaches;
the pain relievers included
to experience a heart attack and 30% more likely
to have a stroke than those without chronic pain.
Researchers adjusted the results for diabetes and
other factors that raise the risk of heart disease.
What might explain the connection? Pain may
trigger a number of factors linked to poor heart
health, including stress, reduced ability to exercise,
poor sleep, and depression, the authors say.

ϐϐ Are women’s heart attacks really that different from men’s?

What’s coming up: ϐϐ Telemedicine for heart disease
ϐϐ Hot baths and saunas: Good for your heart?
ϐϐ What Twitter posts say about a popular heart drug

8 | Harvard Heart Letter | September 2020 www.health.harvard.edu

This Harvard Health Publication was prepared exclusively for Jefferson Malayao - Purchased at https://www.health.harvard.edu