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Original Article

Study on Urinary Caffeine and Caffeine Metabolite Levels in American Adults with Coronary Heart Disease: A Cross-Sectional NHANES Study (2009-2014)

Qianqian Li et al. Gan Ke Mengdie Liu Yanjun Chen … Ye Luo Liangxian Qiu

Abstract

Background:

In recent years, the impact of diet and lifestyle on coronary heart disease (CHD) has garnered significant attention. Caffeine, a common dietary component, and its metabolites may influence cardiovascular health.

Objective:

This study aimed to investigate the association between urinary levels of caffeine and its metabolites and the incidence of CHD as well as to assess how these associations vary across different population groups.

Methods:

Data from the NHANES database (2009-2014) were analyzed using multivariable logistic regression models and smooth curve fitting techniques. Participants were categorized into a control group (n = 5,005) and a CHD group (n = 222) based on CHD status. Urinary levels of caffeine and its metabolites were measured and recorded. Multivariable logistic regression was used to evaluate the association between urinary caffeine/metabolite levels and CHD incidence, while smooth curve fitting was employed to explore potential nonlinear relationships. A significance level of 5% was used to determine statistical significance.

Results:

Higher urinary paraxanthine levels were associated with a lower risk of CHD. In contrast, elevated urinary caffeine levels were positively associated with CHD incidence among Mexican Americans, an association not observed in other racial/ethnic groups.

Conclusion:

Lower urinary paraxanthine levels may reflect a reduced risk of CHD, while higher urinary caffeine levels could indicate an increased CHD risk in specific populations.

  • caffeine
  • Cardiovascular disease
  • Coffee Metabolites
  • Race
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Creative Commons Attribution (CC BY) Creative Commons license
01/12/2025 DOI: 10.36660/abc.20240425i Views 2
Figure 1
ABCHF
Review Article

Hydralazine and Isosorbide Dinitrate in Heart Failure: From Evidence to Clinical Practice

Miguel Morita Fernandes-Silva et al. Ana Carolina Krachinski de Andrade Gama Gabriela Yumi Konno Saito Bruna Czelusniak Goulart … Even Edilce Mol Marco Stephan Lofrano-Alves

Abstract

The treatment of heart failure (HF) with reduced ejection fraction (HFrEF) has evolved significantly over time, with the emergence of various pharmacotherapies targeting different pathophysiological pathways. While neurohumoral antagonists like angiotensin converting enzyme (ACE) inhibitors and beta-blockers have become first-line therapies, the main paradigm shift occurred with medications with vasodilatory effects, including the combination of hydralazine and isosorbide dinitrate (H-ISDN). Although the role of H-ISDN has been overshadowed over time, it remains significant, particularly in certain populations.

With proven hemodynamic benefits in HF by reducing both preload and afterload, H-ISDN was initially tested in the 1980s in the Vasodilator Heart Failure Trial I (V-HeFT I), with promising results. Nevertheless, subsequent trials like V-HeFT II indicated that ACE inhibitors were superior to H-ISDN in reducing mortality.

Later, post-hoc analyses of V-HeFT trials suggested a potential benefit of H-ISDN among black patients. This prompted the African-American Heart Failure trial (A-HeFT), which demonstrated a significant reduction in mortality with H-ISDN in black patients with HFrEF, who were under standard HF treatment including ACE inhibitors.

Current guidelines recommend H-ISDN in black patients with HFrEF who remain symptomatic despite optimized therapy or in those who cannot tolerate ACE inhibitors or angiotensin receptor blockers. However, the use of H-ISDN in other racial groups and in certain clinical scenarios like decompensated HF or renal failure remains less clear due to limited evidence. In this article, we review the history, pharmacological mechanisms, and clinical evidence for the H-ISDN in the treatment of HFrEF.

  • Heart Failure
  • Hydralazine
  • Isosorbide Dinitrate
  • Race
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Creative Commons Attribution (CC BY) Creative Commons license
19/07/2024 DOI: 10.36660/abchf.20240019i Views 1
ABC
Artigo Original

Race and hypertensive target-organ damage in patients from an university-affiliated outpatient care referral clinic in the city of Salvador

Antonio Carlos Beisl Noblat et al. Marcelo Barreto Lopes Antonio Alberto Lopes

OBJECTIVE: To assess whether a patient’s race is associated with the presence of left ventricular hypertrophy, stroke, and renal failure in hypertensive patients from an outpatient care referral clinic in the city of Salvador in the state of Bahia. METHODS: We assessed the data of 622 patients collected during their first visit to the hypertension outpatient care clinic between 1982 and 1986, identifying those with a previous history or sequela of stroke, left ventricular hypertrophy, or renal failure (serum creatinine > 1.4 mg/dL). Logistic regression models were used to estimate the odds ratio (OR) of the association between race (mulattos or black vs white individuals) and hypertensive target-organ damage adjusted for sex and age. RESULTS: The mean age of the patients was 53.8±14.3 years, and 74.1% were women. In regard to race, 15.1% were white, 65.9% mulatto, and 19.0% black. Stroke was significantly more frequent in blacks or mulattos than in white individuals [adjusted odds ratio (aOR) = 3.44; 95% confidence interval (CI) = (1.23-9.67). In regard to the associations involving race and the events of left ventricular hypertrophy and renal failure, the aORs were not statistically significant but were consistent with a greater prevalence of left ventricular hypertrophy and renal failure in blacks and mulattos. CONCLUSION: Hypertensive mulattos and blacks have a greater risk of target-organ damage than white individuals do, with a greater racial difference for nonfatal stroke. Whether racial differences in mortality related to hypertensive complications influence the associations observed between race and target-organ damage should be assessed.

  • arterial hypertension
  • blacks
  • Race
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Creative Commons Attribution (CC BY) Creative Commons license
16/03/2004 DOI: 10.1590/S0066-782X2004000200002 Views 1

How to cite this article

EndNote RIS

Electronic Document Format (Vancouver)

Li Q, Ke G, Liu M, Chen Y, Luo Y, Qiu L. Study on Urinary Caffeine and Caffeine Metabolite Levels in American Adults with Coronary Heart Disease: A Cross-Sectional NHANES Study (2009-2014). Arquivos Brasileiros de Cardiologia 2025;122(9):e20240425.

Electronic Document Format (ABNT)

Li, Qianqian; Ke, Gan; Liu, Mengdie; Chen, Yanjun; Luo, Ye; Qiu, Liangxian. Study on Urinary Caffeine and Caffeine Metabolite Levels in American Adults with Coronary Heart Disease: A Cross-Sectional NHANES Study (2009-2014). Arquivos Brasileiros de Cardiologia, v. 122, n. 9, e20240425, Nov. 2025.

Electronic Document Format (APA)

Li, Q., Ke, G., Liu, M., Chen, Y., Luo, Y., & Qiu, L. (2025). Study on Urinary Caffeine and Caffeine Metabolite Levels in American Adults with Coronary Heart Disease: A Cross-Sectional NHANES Study (2009-2014). Arquivos Brasileiros de Cardiologia, 122(9), e20240425.

Electronic Document Format (ISO)

Li, Qianqian and Ke, Gan and Liu, Mengdie and Chen, Yanjun and Luo, Ye and Qiu, Liangxian. Study on Urinary Caffeine and Caffeine Metabolite Levels in American Adults with Coronary Heart Disease: A Cross-Sectional NHANES Study (2009-2014). Arquivos Brasileiros de Cardiologia [online]. 2025, vol. 122, n. 9, [cited 2026-10-14], e20240425. Available from: <https://journals.cardiol.br/en/article/study-on-urinary-caffeine-and-caffeine-metabolite-levels-in-american-adults-with-coronary-heart-disease-a-cross-sectional-nhanes-study-2009-2014/>. ISSN 0066-782X

EndNote RIS

Electronic Document Format (Vancouver)

Fernandes-Silva MM, Gama ACKA, Saito GYK, Goulart BC, Mol EE, Lofrano-Alves MS. Hydralazine and Isosorbide Dinitrate in Heart Failure: From Evidence to Clinical Practice. ABC Heart Fail Cardiomyop 2024;4(1):e20240019.

Electronic Document Format (ABNT)

Fernandes-Silva, Miguel Morita; Gama, Ana Carolina Krachinski de Andrade; Saito, Gabriela Yumi Konno; Goulart, Bruna Czelusniak; Mol, Even Edilce; Lofrano-Alves, Marco Stephan. Hydralazine and Isosorbide Dinitrate in Heart Failure: From Evidence to Clinical Practice. ABC Heart Fail Cardiomyop, v. 4, n. 1, e20240019, Jul. 2024.

Electronic Document Format (APA)

Fernandes-Silva, M. M., Gama, A. C. K. A., Saito, G. Y. K., Goulart, B. C., Mol, E. E., & Lofrano-Alves, M. S. (2024). Hydralazine and Isosorbide Dinitrate in Heart Failure: From Evidence to Clinical Practice. ABC Heart Fail Cardiomyop, 4(1), e20240019.

Electronic Document Format (ISO)

Fernandes-Silva, Miguel Morita and Gama, Ana Carolina Krachinski de Andrade and Saito, Gabriela Yumi Konno and Goulart, Bruna Czelusniak and Mol, Even Edilce and Lofrano-Alves, Marco Stephan. Hydralazine and Isosorbide Dinitrate in Heart Failure: From Evidence to Clinical Practice. ABC Heart Fail Cardiomyop [online]. 2024, vol. 4, n. 1, [cited 2026-10-14], e20240019. Available from: <https://journals.cardiol.br/en/article/hydralazine-and-isosorbide-dinitrate-in-heart-failure-from-evidence-to-clinical-practice/>

EndNote RIS

Electronic Document Format (Vancouver)

Noblat ACB, Lopes MB, Lopes AA. Race and hypertensive target-organ damage in patients from an university-affiliated outpatient care referral clinic in the city of Salvador. Arquivos Brasileiros de Cardiologia 2004;82(2):111-5.

Electronic Document Format (ABNT)

Noblat, Antonio Carlos Beisl; Lopes, Marcelo Barreto; Lopes, Antonio Alberto. Race and hypertensive target-organ damage in patients from an university-affiliated outpatient care referral clinic in the city of Salvador. Arquivos Brasileiros de Cardiologia, v. 82, n. 2, p. 111-115, Mar. 2004.

Electronic Document Format (APA)

Noblat, A. C. B., Lopes, M. B., & Lopes, A. A. (2004). Race and hypertensive target-organ damage in patients from an university-affiliated outpatient care referral clinic in the city of Salvador. Arquivos Brasileiros de Cardiologia, 82(2), 111-115.

Electronic Document Format (ISO)

Noblat, Antonio Carlos Beisl and Lopes, Marcelo Barreto and Lopes, Antonio Alberto. Race and hypertensive target-organ damage in patients from an university-affiliated outpatient care referral clinic in the city of Salvador. Arquivos Brasileiros de Cardiologia [online]. 2004, vol. 82, n. 2, [cited 2026-10-14], pp. 111-115. Available from: <https://journals.cardiol.br/en/article/race-and-hypertensive-target-organ-damage-in-patients-from-an-university-affiliated-outpatient-care-referral-clinic-in-the-city-of-salvador/>. ISSN 0066-782X

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