Ticagrelor is a potent reversible P2Y 12 inhibitor that reduces ischemic risk in patients with acute coronary syndromes 1 and in those who need long‐term secondary prevention after myocardial infarction (MI). High‐risk patients with prior myocardial infarction, including those with polyvascular disease who chose to take caffeine, do not appear to be at heightened risk of cardiovascular events.Īlthough several studies, including this one, observed an inverse association between caffeine and cardiovascular risk, these observations should be viewed as hypothesis generating randomized trials would be necessary to confirm a benefit. 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).ĭespite the possible link between adenosine and dyspnea on ticagrelor, our data do not support a recommendation of drinking caffeine to alleviate this adverse reaction. 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). Dyspnea analyses considered the pooled ticagrelor group, whereas cardiovascular outcome analyses included patients from the 3 randomized arms. Outcomes of interest included dyspnea, major adverse cardiovascular events (ie, the composite of cardiovascular death, myocardial infarction, or stroke), and arrhythmias. Baseline caffeine intake in cups per week was prospectively collected for 9694 patients.
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).
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