Ischemic stroke

Stroke is a leading cause of severe, long-term disability and the third leading cause of death in the United States, affecting more than 700,000 people yearly.¹ Clinic- and population-based studies have documented the role of traditional and novel risk factors.^1,–,3 Most are traits, chronic conditions, or behaviors that affect the risk of stroke following many years of exposure. Less is known about potential triggers of stroke in the period immediately preceding stroke onset, such as physical exercise, drug use, and intake of alcohol or coffee. Coffee is of particular interest because of its widespread use. Consumption in some countries exceeds 10 kilograms per person per year, which corresponds to more than 100 g of pure caffeine per year. Caffeine may well be the most widely consumed drug in the world,⁴ but coffee consumption is socially acceptable and is generally thought to be a safe habit.

In this issue of Neurology®, Mostofsky and colleagues⁵ challenge the idea of coffee being safe. They test the hypothesis that coffee intake is associated with a transient increase in risk of ischemic stroke. In a multicenter case-crossover study, they studied 390 subjects after an acute ischemic stroke event. Each subject's coffee consumption in the hour before stroke …