Caffeinated Beverage Intake, Dyspnea With Ticagrelor, and Cardiovascular Outcomes: Insights From the PEGASUS‐TIMI 54 Trial
Background A proposed cause of dyspnea induced by ticagrelor is an increase in adenosine blood levels. Because caffeine is an adenosine antagonist, it can potentially improve drug tolerability with regard to dyspnea. Furthermore, association between caffeine and cardiovascular events is of clinical...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.015785 |
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| author | Remo H. M. Furtado Ramkumar V. Venkateswaran Jose C. Nicolau Yared Gurmu Deepak L. Bhatt Robert F. Storey P. Gabriel Steg Giuglia Magnani Shinya Goto Mikael Dellborg Gabriel Kamensky Daniel Isaza Philip Aylward Per Johanson Marc P. Bonaca |
| author_facet | Remo H. M. Furtado Ramkumar V. Venkateswaran Jose C. Nicolau Yared Gurmu Deepak L. Bhatt Robert F. Storey P. Gabriel Steg Giuglia Magnani Shinya Goto Mikael Dellborg Gabriel Kamensky Daniel Isaza Philip Aylward Per Johanson Marc P. Bonaca |
| author_sort | Remo H. M. Furtado |
| collection | DOAJ |
| description | Background A proposed cause of dyspnea induced by ticagrelor is an increase in adenosine blood levels. Because caffeine is an adenosine antagonist, it can potentially improve drug tolerability with regard to dyspnea. Furthermore, association between caffeine and cardiovascular events is of clinical interest. Methods and Results This prespecified analysis used data from the PEGASUS TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis in Myocardial Infarction 54) trial, which randomized 21 162 patients with prior myocardial infarction to ticagrelor 60 mg or 90 mg or matching placebo (twice daily). Baseline caffeine intake in cups per week was prospectively collected for 9694 patients. Outcomes of interest included dyspnea, major adverse cardiovascular events (ie, the composite of cardiovascular death, myocardial infarction, or stroke), and arrhythmias. Dyspnea analyses considered the pooled ticagrelor group, whereas cardiovascular outcome analyses included patients from the 3 randomized arms. After adjustment, caffeine intake, compared with no intake, was not associated with lower rates of dyspnea in patients taking ticagrelor (adjusted hazard ratio (HR), 0.91; 95% CI, 0.76–1.10; P=0.34). There was no excess risk with caffeine for major adverse cardiovascular events (adjusted HR, 0.78; 95% CI, 0.63–0.98; P=0.031), sudden cardiac death (adjusted HR, 0.98; 95% CI, 0.57–1.70; P=0.95), or atrial fibrillation (adjusted odds ratio, 1.07; 95% CI, 0.56–2.04; P=0.84). Conclusions In patients taking ticagrelor for secondary prevention after myocardial infarction, caffeine intake at baseline was not associated with lower rates of dyspnea compared with no intake. Otherwise, caffeine appeared to be safe in this population, with no apparent increase in atherothrombotic events or clinically significant arrhythmias. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01225562. |
| first_indexed | 2024-04-14T07:14:38Z |
| format | Article |
| id | doaj.art-6384ab839e054078afa8fae396ae37f5 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-14T07:14:38Z |
| publishDate | 2020-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6384ab839e054078afa8fae396ae37f52022-12-22T02:06:20ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-05-0191010.1161/JAHA.119.015785Caffeinated Beverage Intake, Dyspnea With Ticagrelor, and Cardiovascular Outcomes: Insights From the PEGASUS‐TIMI 54 TrialRemo H. M. Furtado0Ramkumar V. Venkateswaran1Jose C. Nicolau2Yared Gurmu3Deepak L. Bhatt4Robert F. Storey5P. Gabriel Steg6Giuglia Magnani7Shinya Goto8Mikael Dellborg9Gabriel Kamensky10Daniel Isaza11Philip Aylward12Per Johanson13Marc P. Bonaca14TIMI Study Group Brigham and Women’s Hospital Harvard Medical School Boston MATIMI Study Group Brigham and Women’s Hospital Harvard Medical School Boston MAInstituto do Coracao (InCor) Hospital das Clinicas da Faculdade de Medicina Universidade de Sao Paulo BrazilTIMI Study Group Brigham and Women’s Hospital Harvard Medical School Boston MATIMI Study Group Brigham and Women’s Hospital Harvard Medical School Boston MAUniversity of Sheffield United KingdomUniversité de Paris, and Assistance Publique‐Hôpitaux de Paris Paris FranceUniversity Hospital of Parma ItalyDepartment of Medicine (Cardiology) Tokai University Hospital Isehara JapanSahlgrenska Academy University of Gothenburg SwedenDepartment of Non‐invasive Cardiovascular Diagnostics University Hospital Bratislava Bratislava SlovakiaFundacion Cardioinfantil Instituto de Cardiologia Bogotá ColombiaSouth Australian Health and Medical Research Institute Flinders University and Medical Centre Adelaide AustraliaAstraZeneca Mölndal SwedenTIMI Study Group Brigham and Women’s Hospital Harvard Medical School Boston MABackground A proposed cause of dyspnea induced by ticagrelor is an increase in adenosine blood levels. Because caffeine is an adenosine antagonist, it can potentially improve drug tolerability with regard to dyspnea. Furthermore, association between caffeine and cardiovascular events is of clinical interest. Methods and Results This prespecified analysis used data from the PEGASUS TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis in Myocardial Infarction 54) trial, which randomized 21 162 patients with prior myocardial infarction to ticagrelor 60 mg or 90 mg or matching placebo (twice daily). Baseline caffeine intake in cups per week was prospectively collected for 9694 patients. Outcomes of interest included dyspnea, major adverse cardiovascular events (ie, the composite of cardiovascular death, myocardial infarction, or stroke), and arrhythmias. Dyspnea analyses considered the pooled ticagrelor group, whereas cardiovascular outcome analyses included patients from the 3 randomized arms. After adjustment, caffeine intake, compared with no intake, was not associated with lower rates of dyspnea in patients taking ticagrelor (adjusted hazard ratio (HR), 0.91; 95% CI, 0.76–1.10; P=0.34). There was no excess risk with caffeine for major adverse cardiovascular events (adjusted HR, 0.78; 95% CI, 0.63–0.98; P=0.031), sudden cardiac death (adjusted HR, 0.98; 95% CI, 0.57–1.70; P=0.95), or atrial fibrillation (adjusted odds ratio, 1.07; 95% CI, 0.56–2.04; P=0.84). Conclusions In patients taking ticagrelor for secondary prevention after myocardial infarction, caffeine intake at baseline was not associated with lower rates of dyspnea compared with no intake. Otherwise, caffeine appeared to be safe in this population, with no apparent increase in atherothrombotic events or clinically significant arrhythmias. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01225562.https://www.ahajournals.org/doi/10.1161/JAHA.119.015785arrhythmiascaffeinecardiovascular outcomesdyspneaticagrelor |
| spellingShingle | Remo H. M. Furtado Ramkumar V. Venkateswaran Jose C. Nicolau Yared Gurmu Deepak L. Bhatt Robert F. Storey P. Gabriel Steg Giuglia Magnani Shinya Goto Mikael Dellborg Gabriel Kamensky Daniel Isaza Philip Aylward Per Johanson Marc P. Bonaca Caffeinated Beverage Intake, Dyspnea With Ticagrelor, and Cardiovascular Outcomes: Insights From the PEGASUS‐TIMI 54 Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease arrhythmias caffeine cardiovascular outcomes dyspnea ticagrelor |
| title | Caffeinated Beverage Intake, Dyspnea With Ticagrelor, and Cardiovascular Outcomes: Insights From the PEGASUS‐TIMI 54 Trial |
| title_full | Caffeinated Beverage Intake, Dyspnea With Ticagrelor, and Cardiovascular Outcomes: Insights From the PEGASUS‐TIMI 54 Trial |
| title_fullStr | Caffeinated Beverage Intake, Dyspnea With Ticagrelor, and Cardiovascular Outcomes: Insights From the PEGASUS‐TIMI 54 Trial |
| title_full_unstemmed | Caffeinated Beverage Intake, Dyspnea With Ticagrelor, and Cardiovascular Outcomes: Insights From the PEGASUS‐TIMI 54 Trial |
| title_short | Caffeinated Beverage Intake, Dyspnea With Ticagrelor, and Cardiovascular Outcomes: Insights From the PEGASUS‐TIMI 54 Trial |
| title_sort | caffeinated beverage intake dyspnea with ticagrelor and cardiovascular outcomes insights from the pegasus timi 54 trial |
| topic | arrhythmias caffeine cardiovascular outcomes dyspnea ticagrelor |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.015785 |
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