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From the Departments of Nutrition (Drs. Ascherio and Chen), Epidemiology (Drs. Ascherio, Zhang, and Colditz), and Environmental Health (Dr. Speizer), Harvard School of Public Health; the Department of Neurology (Dr. Schwarzschild), Massachusetts General Hospital; the Division of Preventive Medicine and Brigham and Women’s Hospital (Dr. Zhang); and the Channing Laboratory (Drs. Ascherio, Colditz, and Speizer), Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA.
Address correspondence and reprint requests to Dr. Alberto Ascherio, Harvard School of Public Health, Nutrition Department, 665 Huntington Ave., Boston, MA 02115; e-mail: Alberto.Ascherio{at}channing.harvard.edu
Background: Men who regularly consume caffeinated drinks have a lower risk of PD than do nondrinkers, but this relation has not been found in women. Because this sex difference could be due to hormonal effects, the authors examined prospectively the risk of PD according to use of postmenopausal hormones and caffeine intake among participants in the Nurses’ Health Study.
Methods: The study population comprised 77,713 women free of PD, stroke, or cancer at baseline, who were postmenopausal at baseline or reached menopause before the end of the study. During 18 years of follow-up the authors documented 154 cases of PD.
Results: Overall, the risk of PD was similar in women using hormones and women who never used hormones (relative risk 1.02, 95% CI 0.69 to 1.52). Use of hormones, however, was associated with a reduced risk of PD among women with low caffeine consumption (RR 0.39, 95% CI 0.13 to 1.17), and with increased risk among women with high caffeine consumption (RR 2.44, 95% CI 0.75 to 7.86; p for interaction = 0.01). Among hormone users, women consuming six or more cups of coffee per day had a fourfold higher risk of PD (RR 3.92, 95% CI 1.49 to 10.34; p = 0.006) than did women who never drink coffee.
Conclusion: These results suggest that caffeine reduces the risk of PD among women who do not use postmenopausal hormones, but increases risk among hormone users. Clinical trials of caffeine or estrogens in women should avoid the combined use of these agents.
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