Dear Dr. Roach: I read on the internet that coffee is full of antioxidants. Is this true?
L.C.
The simple answer is that yes, coffee has lots of antioxidants. At least six different families of antioxidant compounds are found in coffee that has been roasted and brewed, the way coffee is almost always consumed in North America.
What makes the answer more complicated is whether there is evidence that the antioxidants in coffee lead to improvement in things that are meaningful, such as reducing risk of heart attack or increasing lifespan. Powerful antioxidants, such as folic acid, quercetin, resveratrol, vitamins E and C, and N-acetylcysteine, have shown no benefit in reducing risk, in multiple studies, used mostly individually or in small combinations. Studies on cells have shown increases in cellular damage in experimental subjects who took antioxidants, compared with those who took a placebo. The body’s systems are incredibly complex, and we don’t know enough to predict what will happen when a person takes multiple compounds, such as those within coffee, without large-scale studies.
Fortunately, we do have high-quality, long-term data, most of which confirms a benefit in reducing overall mortality risk among coffee drinkers. Benefits were seen for heart disease and stroke, as well as in multiple other causes, but not for cancer. Whether it is a specific antioxidant in coffee or the whole combination, or even whether these results will be confirmed in future trials, are not answerable at the present time. I’m not a coffee drinker, and these results aren’t enough for me to start, but coffee drinkers can rejoice that there appear to be health benefits from their daily brew.
Dear Dr. Roach: I was recently diagnosed with an NSTEMI, after a rise in troponin and EKG changes following a gastrointestinal illness. Can you please discuss causes and necessary testing?
B.L.
“NSTEMI” stands for “non-ST elevation myocardial infarction.” This is a type of heart attack. Virtually all heart attacks are caused by blockages in the arteries that supply blood to the heart muscle. Inflammation of the heart muscle, dissection of a major artery or stress-induced cardiomyopathy is the cause.
The ST-segment is part of the electrocardiogram that, for decades, had been a major criterion in making the diagnosis of a heart attack. However, it was discovered that heart cells, when damaged, release enzymes that can now be detected in the blood in very low amounts, and this has changed the way we diagnose acute coronary syndromes. When a person has symptoms that suggest heart attack, the troponin test will show whether there is damage to the heart cells. We call the syndrome “unstable angina” when a person comes in with symptoms suggesting a heart attack, but without troponin in the blood, while an NSTEMI has elevated troponin. At the time of the event, cardiologists consider whether to look for and open any blocked blood vessels with an angiogram and revascularization (like a balloon and a stent). Occasionally, there are blockages of such a type that surgery is the best option.
After the event, medical therapy (aspirin, beta blockers and a statin at a minimum, on top of lifestyle modification) can drastically reduce the risk of another acute coronary syndrome. Risk stratification, with a stress test or angiogram, will sometimes be recommended in people who have had an NSTEMI.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
