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January 21, 1974

Coffee and Infarction

JAMA. 1974;227(3):325. doi:10.1001/jama.1974.03230160053021

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To the Editor.—  The article by Klatsky et al (226:540, 1973), "Coffee Drinking Prior to Acute Myocardial Infarction," has at least two basic flaws that cast doubt on the authors' conclusion that "Coffee drinking is not an established risk factor for myocardial infarction."First of all, since this was a study of hospital charts, it is obvious that only survivors of acute myocardial infarction are included. In a "captured population" such as that at Kaiser-Permanente, it would be interesting to have a prospective study that included cases of sudden death as well as cases hospitalized for myocardial infarction. Such a prospective study, including cases of sudden death, would be far more convincing than the retrospective study of hospital cases.The second issue of concern is that the conclusions were based on a single cut point for coffee drinking using the criterion of six cups of coffee per day. Since any