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Smoking and caffeine have a synergistic detrimental effect on aortic stiffness and wave reflections
Open accessAbstract
Objectives We investigated the acute and chronic combined effect of cigarette smoking and caffeine intake on aortic stiffness and wave reflections.Background We have shown that smoking and caffeine separately increase arterial stiffness. Aortic stiffness and wave reflections are important determinants of the efficient performance of the cardiovascular system and prognosticators of cardiovascular risk.Methods The acute effects of smoking (one cigarette), caffeine (200 mg, equivalent to 2 cups of coffee), and smoking plus caffeine were studied in 24 healthy subjects according to a randomized, placebo- and sham procedure-controlled crossover design. The chronic effect of smoking and caffeine was studied in a population study that enrolled 160 healthy subjects.Results Acute study: there was a significant interaction between caffeine and smoking with regard to pulse-wave velocity (p < 0.01) and augmentation index (p < 0.05). When smoking followed caffeine intake, pulse-wave velocity and augmentation index increased further by 0.52 m/s and 13.4%, respectively, reaching a total of 0.85 m/s and 17.4%, 0.17 m/s and 9.2% in excess of the mere sum of caffeine effect (0.33 m/s and 4%) alone and smoking effect alone (0.35 m/s and 4.2%). Population study: there was a significant interaction of chronic coffee consumption and smoking regarding pulse-wave velocity (p < 0.05) and augmentation index (p = 0.001).Conclusions The present study shows, for the first time, that when smoking and caffeine intake are combined, they interact and exert a synergistic, unfavorable effect on aortic stiffness and wave reflections on both an acute and chronic basis.
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TL;DR
In healthy adults, combined caffeine and smoking produced acute synergistic worsening of aortic stiffness and wave reflections beyond the sum of their individual effects. A chronic population study also found significant interactions between coffee drinking and smoking on pulse-wave velocity, augmentation index, augmented pressure, and subendocardial viability index.
Key findings
- Acute study: significant caffeine–smoking interaction for pulse-wave velocity (p < 0.01) and heart-rate-corrected augmentation index (p < 0.05). When smoking followed caffeine, pulse-wave velocity increased further by 0.52 m/s to a total of 0.85 m/s, 0.17 m/s above the sum of caffeine alone (0.33 m/s) and smoking alone (0.35 m/s); augmentation index increased further by 13.4% to 17.4%, 9.2% above the sum of caffeine alone (4%) and smoking alone (4.2%).
- Acute central pressures also showed significant interaction: smoking after caffeine increased central systolic, diastolic, and pulse pressures further by 7.5, 4.4, and 3.1 mm Hg, reaching peak increases of 16.4, 11.7, and 4.7 mm Hg, respectively. Ejection duration decreased further by 16.2 ms to −16.6 ms, 11.7 ms less than the sum of individual effects; subendocardial viability index interaction was p < 0.001.
- Population study: among 160 subjects, chronic coffee consumption and smoking interacted significantly for pulse-wave velocity (p < 0.05), augmentation index (p = 0.001), augmented pressure (p < 0.005), and subendocardial viability index (p = 0.001). Table values showed pulse-wave velocity 6.36 m/s in coffee drinkers/smokers, 6.31 m/s in coffee drinkers/nonsmokers, and 5.80 m/s in neither (p = 0.05); augmentation index 22.7%, 21.7%, and 11.0% (p = 0.001); subendocardial viability index 145.0%, 140.8%, and 156.1% (p = 0.005).
- No effect of gender was found on any of the significant interactions.
Methods
- Acute study: randomized, placebo- and sham procedure-controlled crossover design in 24 healthy current smokers and regular caffeine consumers (>100 mg/day). Four sessions were smoking one standard cigarette (1.1 mg nicotine) over 5 min, sham smoking, caffeine 200 mg plus smoking 60 min later, and placebo plus sham smoking. Aortic stiffness was studied in 14 subjects (7 women, 7 men; age 30 ± 2 years) and wave reflections in 10 subjects (5 women, 5 men; age 33 ± 3 years).
- Population study: 160 clinically healthy employees (79% participation rate) were grouped as 97 chronic smokers and coffee drinkers, 41 chronic coffee drinkers and nonsmokers, 2 chronic smokers but not coffee drinkers (data not shown), and 20 neither coffee consumers nor smokers. Measurements were taken in the morning after an overnight fast.
- Main measures/analysis: carotid–femoral pulse-wave velocity (Complior) and augmentation index, augmented pressure, and subendocardial viability index (SphygmoCor). Multi-way analysis of covariance for repeated measurements was used, with adjustments for mean pressure, heart rate, age, and gender; Bonferroni correction was applied. Power calculation indicated 160 participants provided >0.80 power at p < 0.05.
Limitations
- Stated: the study refers to young, apparently healthy adults, and results might not be directly extendable to other population groups. The basic mechanism responsible for the interactive effect is unclear.
- Stated/evident: the population groups differed significantly in age (p = 0.001), although analyses were age-adjusted; the chronic population study is cross-sectional and cannot establish causality.
- Evident: the acute study sample was small (24 total; 14 and 10 in the two measurement groups), and all acute participants were current smokers and regular caffeine consumers, limiting generalizability.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Population study: there was a significant interaction of chronic coffee consumption and smoking regarding pulse-wave velocity (p Ͻ 0.05)”
- Also stated in: § Population study. · hedged
“Furthermore, a significant interaction was observed between chronic smoking and coffee consumption on pulse-wave velocity (p Ͻ 0.05), indicating a synergistic effect of the two habits.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The observed associations between chronic smoking/coffee consumption and arterial stiffness are not due to unmeasured confounding.
- Also stated in: § Population study. · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and augmentation index (p ϭ 0.001)”
- Also stated in: § Population study. · plain
“In addition, a significant interaction was observed between chronic smoking and coffee consumption on the augmentation index and augmented pressure (p ϭ 0.001 and p Ͻ 0.005, respectively) after correction for height and HR.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The observed associations between chronic smoking/coffee consumption and arterial stiffness are not due to unmeasured confounding.
- Also stated in: § Population study. · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“there was a significant interaction between caffeine and smoking with regard to pulse-wave velocity (p Ͻ 0.01)”
- Also stated in: § Acute study. · plain
“There was a significant interaction (p Ͻ 0.01) between caffeine and smoking regarding pulse-wave velocity, indicating a synergistic effect of the two interventions leading to a significant deterioration in aortic stiffness.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The acute effects of smoking and caffeine on arterial stiffness are not affected by carryover effects between the four study sessions.
- Also stated in: § Acute study. · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and augmentation index (p Ͻ 0.05)”
- Also stated in: § 2, diamonds). · plain
“There was a significant interaction (p Ͻ 0.05) between caffeine and smoking with regard to augmentation index corrected for changes in HR, indicating a synergistic effect of the two interventions leading to a significant increase in wave reflections.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The acute effects of smoking and caffeine on arterial stiffness are not affected by carryover effects between the four study sessions.
- Also stated in: § 2, diamonds). · plain
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“This is also corroborated by the fact that the increase in the aortic stiffness when smoking was added to caffeine was proportionally larger than the respective increase in blood pressure.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, a significant interaction was observed between chronic smoking and coffee consumption on the augmentation index and augmented pressure (p ϭ 0.001 and p Ͻ 0.005, respectively) after correction for height and HR.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Population study.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The observed associations between chronic smoking/coffee consumption and arterial stiffness are not due to unmeasured confounding.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no effect of gender on any of these interactions.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Population study.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Furthermore, a significant interaction was observed between chronic smoking and coffee consumption on the subendocardial viability index (p ϭ 0.001) after correction for HR.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Population study.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The observed associations between chronic smoking/coffee consumption and arterial stiffness are not due to unmeasured confounding.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Coffee consumers/nonsmokers, as well as coffee consumers/smokers, had increased pulse wave velocity levels compared with non-coffee consumers/nonsmokers (p Ͻ 0.05 for both).”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Population study.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The observed associations between chronic smoking/coffee consumption and arterial stiffness are not due to unmeasured confounding.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, a significant interaction was observed between chronic smoking and coffee consumption on the augmentation index and augmented pressure (p ϭ 0.001 and p Ͻ 0.005, respectively) after correction for height and HR.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Population study.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The observed associations between chronic smoking/coffee consumption and arterial stiffness are not due to unmeasured confounding.
- It may state two separate claims as one. 9
- Probably not a substantial claim. 11
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When smoking followed caffeine intake, pulse-wave velocity and augmentation index increased further by 0.52 m/s and 13.4%, respectively, reaching a total of 0.85 m/s and 17.4%, 0.17 m/s and 9.2% in excess of the mere sum of caffeine effect (0.33 m/s and 4%) alone and smoking effect alone (0.35 m/s and 4.2%).”
- Also stated in: § 2, diamonds). · plain
“When smoking followed caffeine intake, the augmentation index increased to 17.4%, 9.2% in excess of the mere sum of caffeine effect (4%) alone and smoking effect alone (4.2%) (Fig. 3, diamonds).”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The acute effects of smoking and caffeine on arterial stiffness are not affected by carryover effects between the four study sessions.
- Also stated in: § 2, diamonds). · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When smoking followed caffeine intake, pulse-wave velocity and augmentation index increased further by 0.52 m/s and 13.4%, respectively, reaching a total of 0.85 m/s and 17.4%, 0.17 m/s and 9.2% in excess of the mere sum of caffeine effect (0.33 m/s and 4%) alone and smoking effect alone (0.35 m/s and 4.2%).”
- Also stated in: § DISCUSSION · plain
“When smoking followed caffeine intake, pulse wave velocity reached a total increase of 0.85 m/s, 0.17 m/s in excess of the mere sum of caffeine effect (0.33 m/s) alone and smoking effect alone (0.35 m/s) (Fig.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The acute effects of smoking and caffeine on arterial stiffness are not affected by carryover effects between the four study sessions.
- Also stated in: § DISCUSSION · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Coffee consumers/nonsmokers, as well as coffee consumers/smokers, had lower subendocardial viability index levels compared with non-coffee consumers/nonsmokers (p Ͻ 0.005 and p Ͻ 0.05, respectively) after correction for HR.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Population study.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The observed associations between chronic smoking/coffee consumption and arterial stiffness are not due to unmeasured confounding.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Significant interactions between chronic smoking and coffee consumption were also observed regarding peripheral diastolic pressure (p Ͻ 0.05), peripheral and central mean pressure (p Ͻ 0.05), central systolic pressure (p Ͻ 0.05), and central diastolic pressure (p Ͻ 0.05), whereas central pulse pressure showed a marginal trend (p ϭ 0.07).”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Population study.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The observed associations between chronic smoking/coffee consumption and arterial stiffness are not due to unmeasured confounding.
None of the sources cited for this claim have been checked yet.
In the paper
“Large-artery stiffness and wave reflections are important determinants of left ventricular (LV) function, coronary blood flow, and mechanical integrity of arteries and have been identified as markers of cardiovascular disease and independent prognosticators of cardiovascular risk (4 -12).”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Abstract
What the sources say
- Not checked yetcites [4] Nichols, 1998
- Not checked yetcites [5] Vlachopoulos, 2000, Genesis of the normal and abnormal arterial pulse, Curr Probl Cardiol source
- Not checked yetcites [6] Kelly, 1992, Effect of reduced aortic compliance in cardiac efficiency and contractile function of in situ canine left ventricle, Circ Res source
- Not checked yetcites [7] Watanabe, 1993, Coronary circulation in dogs with an experimental decrease in aortic compliance, J Am Coll Cardiol source
- Not checked yetcites [8] Blacher, 1999, Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients, Hypertension source
- Not checked yetcites [9] Stefanadis, 2000, Aortic stiffness as a risk factor for recurrent acute coronary events in patients with ischaemic heart disease, Eur Heart J source
- Not checked yetcites [10] Laurent, 2001, Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients, Hypertension source
- Not checked yetcites [11] London, 2001, Arterial wave reflections and survival in end-stage renal failure, Hypertension source
- Not checked yetcites [12] Weber, 2004, Arterial stiffness, wave reflections, and the risk of coronary artery disease, Circulation source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“We and others have previously shown that active and passive smoking (13)(14)(15) and caffeine (16 -19) increase arterial stiffness and wave reflections.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Abstract
What the sources say
- Not checked yetcites (13)(14)(15)
- Not checked yetcites [16] Vlachopoulos, 2001, Pressure-altering agents affect central aortic pressures more than is apparent from upper limb measurements in hypertensive patients: the role of arterial wave reflections, Hypertension source
- Not checked yetcites [17] Vlachopoulos, 2003, Caffeine increases aortic stiffness in hypertensive patients, Am J Hypertens source
- Not checked yetcites [18] Vlachopoulos, 2003, Effect of caffeine on aortic elastic properties and wave reflection, J Hypertens source
- Not checked yetcites [19] Mahmud, 2001, Acute effect of caffeine on arterial stiffness and aortic pressure waveform, Hypertension source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Large-artery stiffness and wave reflections are important determinants of left ventricular (LV) function, coronary blood flow, and mechanical integrity of arteries and have been identified as markers of cardiovascular disease and independent prognosticators of cardiovascular risk (4 -12).”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Abstract
What the sources say
- Not checked yetcites [4] Nichols, 1998
- Not checked yetcites [5] Vlachopoulos, 2000, Genesis of the normal and abnormal arterial pulse, Curr Probl Cardiol source
- Not checked yetcites [6] Kelly, 1992, Effect of reduced aortic compliance in cardiac efficiency and contractile function of in situ canine left ventricle, Circ Res source
- Not checked yetcites [7] Watanabe, 1993, Coronary circulation in dogs with an experimental decrease in aortic compliance, J Am Coll Cardiol source
- Not checked yetcites [8] Blacher, 1999, Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients, Hypertension source
- Not checked yetcites [9] Stefanadis, 2000, Aortic stiffness as a risk factor for recurrent acute coronary events in patients with ischaemic heart disease, Eur Heart J source
- Not checked yetcites [10] Laurent, 2001, Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients, Hypertension source
- Not checked yetcites [11] London, 2001, Arterial wave reflections and survival in end-stage renal failure, Hypertension source
- Not checked yetcites [12] Weber, 2004, Arterial stiffness, wave reflections, and the risk of coronary artery disease, Circulation source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“The augmentation index was measured by using a validated, commercially available system (SphygmoCor; AtCor Medical, Sydney, Australia) that employs the principle of applanation tonometry and appropriate acquisition and analysis software for noninvasive recording and analysis of the arterial pulse.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Evaluation of aortic elastic properties and wave reflections.
What the sources say
- Not checked yetcites [4] Nichols, 1998
- Not checked yetcites [27] Karamanoglu, 1993, An analysis of the relationship between central aortic and peripheral upper limb pressure waves in man, Eur Heart J source
- Not checked yetcites [28] Chen, 1997, Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure, Circulation source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Because the augmentation index is influenced by changes in heart rate (HR), it was also accordingly corrected (26).”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Evaluation of aortic elastic properties and wave reflections.
What the sources say
- Not checked yetcites [26] Cameron, 1998, Use of radial artery applanation tonometry and a generalized transfer function to determine aortic pressure augmentation in subjects with treated hypertension, J Am Coll Cardiol source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Another interesting interpretation of the results of our study is that neither stimulus”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Consequently, given the frequent combination of smoking and caffeine intake, these effects on arterial function may have important implications for human health.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > DISCUSSION
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
In the paper
“using a validated noninvasive device (Complior; Artech Medical, Pantin, France) that allows online pulse-wave recording and automatic calculation of pulse-wave velocity (25).”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Evaluation of aortic elastic properties and wave reflections.
What the sources say
- Not checked yetcites [25] Asmar, 1995, Assessment of arterial distensibility by automatic pulse wave velocity measurement: validation and clinical application studies, Hypertension source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, because of multiple comparisons, we used the Bonferroni correction in order to account for the increase in type I error.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Evaluation of aortic elastic properties and wave reflections.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“To take into account the potential effect of pressure changes on pulse-wave velocity and of HR changes on subendocardial viability index, we adjusted in multivariate regression models for mean pressure and HR, respectively.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Evaluation of aortic elastic properties and wave reflections.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study refers to young, apparently healthy adults, and results might not be directly extendable to other population groups.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > DISCUSSION
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Wave reflection indices may be influenced by changes in HR and by height and subendocardial viability index by changes in HR.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > DISCUSSION
What the sources say
- Not checked yetcites [26] Cameron, 1998, Use of radial artery applanation tonometry and a generalized transfer function to determine aortic pressure augmentation in subjects with treated hypertension, J Am Coll Cardiol source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The study was carried out using a randomized placebo-and sham procedurecontrolled crossover design.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Study design. ACUTE STUDY.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The involvement of the interaction between chronic coffee intake and smoking on the investigated parameters was evaluated using multi-way analysis of covariance after adjusting for age and gender.”
- Also stated in: § Population study. · plain
“Because the age of the participants differed significantly in the groups of the study, all the analyses carried out were age-adjusted.”
§ Smoking and Caffeine Have a Synergistic Detrimental Effect on Aortic Stiffness and Wave Reflections > Evaluation of aortic elastic properties and wave reflections.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
- Also stated in: § Population study. · plain
The paper relies on this without support.
The observed associations between chronic smoking/coffee consumption and arterial stiffness are not due to unmeasured confounding.
“The involvement of the interaction between chronic coffee intake and smoking on the investigated parameters was evaluated using multi-way analysis of covariance after adjusting for age and gender.”
The paper relies on this without support.
The acute effects of smoking and caffeine on arterial stiffness are not affected by carryover effects between the four study sessions.
“Each subject was studied fasting on four separate days before and after 1) smoking one standard cigarette (1.1 mg nicotine) over 5 min, 2) sham smoking, 3) caffeine intake (200 mg, a dose equivalent to 2 cups of coffee) plus smoking one standard cigarette (1.1 mg nicotine) 60 min after caffeine intake, and 4) placebo (to caffeine) and sham smoking 60 min after placebo intake.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Evidence from experimental studies indicates that coffee acutely increases circulating concentrations of (nor)epinephrine, 2 raises systolic and diastolic blood pressure, 3 increases arterial stiffness, 5,6 and impairs endothelium-dependent vasodilation.7”
From Coffee and acute ischemic stroke onset: The Stroke Onset Study (2010) · cites this paper as [5]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Pulse pressure does not match systolic minus diastolic pressure in the smoking session
MinorIn Table 2's smoking session, peripheral systolic pressure minus diastolic pressure is 50.4 mm Hg, not the reported pulse pressure of 51.2 mm Hg.
Reported 51.2 · recomputed 50.4
“| Peripheral SP (mm Hg) | 120.4 Ϯ 2.5 | 118.4 Ϯ 2.4 | 119.4 Ϯ 2.9 | 122.3 Ϯ 2.5 | NS | | Peripheral DP (mm Hg) | 70.3 Ϯ 1.4 | 70.2 Ϯ 2.4 | 69.0 Ϯ 2.5 | 68.2 Ϯ 1.4 | NS | | Peripheral PP (mm Hg) | 50.2 Ϯ 1.9 | 48.1 Ϯ 1.9 | 51.2 Ϯ 2.3 | 53.3 Ϯ 1.3 | NS |”
Citations
Cites
Laurent, S., Boutouyrie, P., Asmar, R., Gautier, I., Laloux, B., Guize, L., Ducimetiere, P., & Benetos, A. (2001) · Hypertension · doi:10.1161/01.hyp.37.5.1236 · Cited by 3,856
Cigarette smoking among adults — United States, 1988
Bachman, J. G., Johnston, L. D., & O’Malley, P. M. (1992) · Patient Education and Counseling · doi:10.1016/0738-3991(92)90149-d · Cited by 1,705
McDonald's Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles
Vlachopoulos, C., O'Rourke, M., & Nichols, W. W. (2011) · doi:10.1201/b13568 · Cited by 1,613
Self-citationAortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients
Blacher, J., Asmar, R., Djane, S., London, G. M., & Safar, M. E. (1999) · Hypertension · doi:10.1161/01.hyp.33.5.1111 · Cited by 1,493
Asmar, R., Benetos, A., Topouchian, J., Laurent, P., Pannier, B., Brisac, A.-M., Target, R., & Levy, B. I. (1995) · Hypertension · doi:10.1161/01.hyp.26.3.485 · Cited by 1,376
Chen, C.-H., Nevo, E., Fetics, B., Pak, P. H., Yin, F. C. P., Maughan, W. L., & Kass, D. A. (1997) · Circulation · doi:10.1161/01.cir.95.7.1827 · Cited by 1,307
Clinical applications of arterial stiffness; definitions and reference values
O'Rourke, M. F., Staessen, J. A., Vlachopoulos, C., Duprez, D. A., & Plante, G. E. (2002) · American Journal of Hypertension · doi:10.1016/s0895-7061(01)02319-6 · Cited by 1,118
Self-citationCryer, P. E., Haymond, M. W., Santiago, J. V., & Shah, S. D. (1976) · New England Journal of Medicine · doi:10.1056/nejm197609092951101 · Cited by 1,101
Arterial stiffness, wave reflections, and the risk of coronary artery disease
Weber, T., Auer, J., O’Rourke, M. F., Kvas, E., Lassnig, E., Berent, R., & Eber, B. (2004) · Circulation · doi:10.1161/01.cir.0000105767.94169.e3 · Cited by 1,081
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Items 101–135 of 135
Is Coffee and Tea a Threat or Ally to Cardiovascular Health?
Mendpara, V. A., Garg, S., Shah, P., Bhavsar, J., Anamika, F., Patel, M. A., Munjal, R. S., Gupta, V., Garg, N., & Jain, R. (2023) · Cureus · doi:10.7759/cureus.49991 · Cited by 3
“Research has revealed that smoking and coffee can synergistically enhance aortic stiffness [48].”
BackgroundPapadakis, S., Pipe, A., Vlachopoulos, C. V., Ioakeimidis, N., & Katsaounou, P. (2021) · European Respiratory Society eBooks · doi:10.1183/2312508x.10003120 · Cited by 2
Self-citationVlachopoulos, C. V., & Xaplanteris, P. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-801387-8.00026-0 · Cited by 3
Self-citationCafé y enfermedades cardiovasculares
von Wichmann, M. D. L. F. (2009) · Atención Primaria · doi:10.1016/j.aprim.2009.09.002 · Cited by 3
Caffeine and Cardiometabolic Health: Evidence, Controversies, and Clinical Considerations
Kayikcioglu, M., & Ozkan, H. S. (2026) · Nutrition Reviews · doi:10.1093/nutrit/nuag018 · Cited by 1
Caffeine cardiovascular toxicity: too much of a good thing—an update
Deus, C. M., Branco, A. F., Oliveira, P. J., & Sardão, V. A. (2024) · Coffee in Health and Disease Prevention · doi:10.1016/b978-0-443-13868-3.00079-x · Cited by 1
Kałuża, J., Stackelberg, O., Björck, M., & Wolk, A. (2025) · Scientific Reports · doi:10.1038/s41598-025-12668-2 · Cited by 1
“When combined, these effects are amplified, leading to a significant increase in pulse-wave velocity and augmentation index, which are indicators of arterial stiffness and cardiovascular risk 33,34 .”
Pharmacologic and Environmental Factors: Coffee, Smoking, and Sodium
Vlachopoulos, C. V., Pietri, P., & Tousoulis, D. M. (2015) · Springer eBooks · doi:10.1007/978-3-319-14556-3_13 · Cited by 1
Self-citationCaffeine Cardiovascular Toxicity
Deus, C. M., Branco, A. F., Oliveira, P. J., & Sardão, V. A. (2014) · Coffee in Health and Disease Prevention · doi:10.1016/b978-0-12-409517-5.00078-4 · Cited by 1
Rauchen und kardiovaskuläre Erkrankungen
Saner, H. E. (2009) · Kardiovask Med · doi:10.4414/cvm.2009.01456 · Cited by 1
Smoking-Related Disease Risk Reduction Potential of ENDPs
Hoeng, J., Szostak, J., Boué, S., Haziza, C., & Peitsch, M. C. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-820490-0.00023-7 · Cited by 1
Jatoi, N.-A., Al-Baker, W.-I., Almuhanna, A., et al. (2017) · Artery Research · doi:10.1016/j.artres.2017.10.196 · Cited by 1
“4,5 Similarly, Vlachopoulos et al. 6 have shown a significant undesirable effect of smoking and caffeine on arterial stiffness.”
The Process of Cigarette Smoking
Wang, J., & Wang, X. L. (2011) · doi:10.1002/9783527635320.ch3 · Cited by 1
A longitudinal evaluation of novel outcome measures in chronic obstructive pulmonary disease
Albarrati, A. (2014) · ORCA Online Research @Cardiff (Cardiff University)
Significance of Central Aortic Stiffness in Cardiovascular Disease
Arora, R. R., & Khandpur, R. (2008) · American Journal of Therapeutics · doi:10.1097/mjt.0b013e3181727dfc
The Impact of Chronic Cigarette Smoking on Arterial Stiffness in Korea
Kim, J. B., Kang, W. Y., Kim, S. J., Hong, M. J., Park, C. Y., No, H. M., Hong, K. H., Hwang, S. H., & Kim, W. (2011) · Journal of the Korean Geriatrics Society · doi:10.4235/jkgs.2011.15.1.47
“J Korean Geriatr Soc 15(1) March 2011 47 The Impact of Chronic Cigarette Smoking on Arterial Stiffness in Korea”
InfluentialLisowska, A., Musial, W. J., Lewczuk, A., et al. (2006) · Via Medica Journals
Werner, T. J. (2013) · VTechWorks (Virginia Tech)
The effect of coronary artery bypass grafting on aortic functions
Ağca, F. V. (2015) · Turkish Journal of Thoracic and Cardiovascular Surgery · doi:10.5606/tgkdc.dergisi.2015.9581
“[1] Recent studies have revealed that age, smoking, diabetes mellitus (DM), familial hypercholesterolemia, hypertension, endstage renal disease (ESRD), metabolic syndrome, hypothyroidism, and CAD compromise aortic elastic properties, thus inducing functional and histological changes in the aortic wall.[2-4] In patient…”
Sethi, S. (2016) · Tuwhera (Auckland University of Technology)
Jorge, A. J. L., & Mesquita, E. T. (2008)
Acute CardiovascularEffects of Caffeine
Smith, B. D., & Aldridge, K. (2006) · CRC Press eBooks · doi:10.1201/9781420006568.sec2
Coffee and Renal Function and Disease
Catalano, D., Trovato, F. M., Martines, F., & Trovato, G. M. (2014) · Coffee in Health and Disease Prevention · doi:10.1016/b978-0-12-409517-5.00059-0
Blood Pressure Effects of Dietary Caffeine Are a Risk for Cardiovascular Disease
James, J. E. (2006) · CRC Press eBooks · doi:10.1201/9781420006568.ch6
Alabbad, N. (2018) · Arab Universities Journal of Agricultural Sciences · doi:10.21608/ajs.2018.28252
“…نيخدتلا نأب تصلختسا ةديدع تاسارد يباجيلإا(Iribarren et al 1999 ؛Stampfer et al 2000 ؛Hu et al 2000 ؛Conroy et al 2003 ؛Pencina et al 2009 ؛Yary et al 2010 ؛Wild et al 2010 ؛Ezzati and Ribli 2013) يبلسلا وأ(Leone, 2003) لماوع ىدحإ يفو ،ةيومدلا ةيعولأاو بلقلا ضارمأب ةباصلإل ةروطخلا ةساردVlachopoulos…”
Influential(2024) · Elsevier eBooks · doi:10.1016/b978-0-443-15512-3.00050-7
Physical activity, vasomotor endothelial function, and arterial stiffness
Носков, С. М., Заводчиков, А. А., Evgenyeva, A. V., et al. (2012) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2012-6-29-32
de Luis, D. A., Aller, R., & Zarzuelo, S. (2007) · Medicina Clínica · doi:10.1157/13106682
Lifestyle Intervention: What Works?
Xaplanteris, P., & Vlachopoulos, C. V. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-15512-3.00049-0
Self-citationPedroso, A. B., Chemello, D., & Chagas, P. (2024) · Coffee in Health and Disease Prevention · doi:10.1016/b978-0-443-13868-3.00013-2
Masoza, T. S., Andy, C., Willkens, M. A., Kibona, S., Bundschuh, E., Peck, R. N., Kalluvya, S. E., & Reif, L. K. (2026) · HIV Research & Clinical Practice · doi:10.1080/25787489.2026.2725472
Metadata
- Authors
- Vlachopoulos, C., Kosmopoulou, F., Panagiotakos, D., Ioakeimidis, N., Alexopoulos, N., Pitsavos, C., & Stefanadis, C.
- Affiliations
- Hippocration General Hospital (GR)
- Corresponding author
- Vlachopoulos, Charalambos
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2004-11
- Volume
- 44
- Issue
- 9
- Pages
- 1911-1917
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2071910605
- Semantic Scholar
- 4e6712e7fbc3b420c12593d52083904871b3359f
- Cited by
- 135
- References
- 41
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 6 · 2023: 2 · 2022: 6 · 2021: 4 · 2020: 4 · 2019: 6 · 2018: 5 · 2017: 4 · 2016: 6 · 2015: 9 · 2014: 7 · 2013: 6 · 2012: 3
- FWCI
- 7.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Pharmacology (medical) › Coffee research and impacts
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- cigarette smoking, caffeine, coffee consumption, aortic stiffness, arterial stiffness, wave reflection, pulse wave velocity, augmentation index, synergistic interaction, cardiovascular risk
- MeSH terms
- Adult, Central Nervous System Stimulants, Aortic Diseases, Blood Flow Velocity, Blood Pressure, Caffeine, Drug Synergism, Female, Heart Rate, Humans, Male, Myocardial Contraction, Pulsatile Flow, Smoking, Statistics as Topic, Stroke Volume, Cross-Over Studies
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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