Coffee vs The Grim Reaper: Drink Up

Henry R. Black, MD


July 11, 2012

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Hi. I am Dr. Henry Black. I am Clinical Professor of Internal Medicine at the New York University School of Medicine, a member of the Center for the Prevention of Cardiovascular Disease, and a past president of the American Society of Hypertension.

One of the risk factors for heart disease that has always been interesting is alcohol. Many, many studies, including observational and clinical trials, show clearly that the more alcohol you drink, the lower the risk for heart disease. Of course, you would run into [other alcohol-related] troubles, such as suicide, accidents, cirrhosis, and other things. But alcohol itself -- and it probably does not matter what kind of alcohol -- seems to be somewhat protective to the heart.

A similar finding was just observed with coffee.[1] As with alcohol, coffee is one of these things that some of us enjoy but one that is associated with risks for heart disease, cancer, and a whole variety of other complications. But now we have become much more sophisticated in our analyses of large databases, and we now know that we have to make adjustments for what else happens when you drink coffee. The classic study of pancreatic cancer and coffee was conducted about 30 years ago, when coffee was blamed as being responsible for pancreatic cancer -- until it turned out that people who drank coffee usually also smoked.

This question has been readdressed by an NIH/AARP [National institutes of Health/American Association of Retired Persons] study. This study enrolled more than 400,000 participants from age 51 to over 70 years, and more than 52,000 deaths were accrued from the National Death Index. It included participants from 6 states plus Atlanta and Detroit. The findings are extremely interesting. The investigators looked at people who drank no coffee, less than 1 cup, 2-3 cups, 4-5 cups, or more than 6 cups, and then they tallied the rates of all-cause mortality -- deaths in people with heart disease, stroke, diabetes, respiratory disease, cancer, and the other usual conditions you look at.

Then they adjusted for other factors, such as white meat intake, red meat intake, total calories, smoking, and the kind of coffee consumed. The findings completely changed at that point. When the data were adjusted for those other factors, the clear offender was cigarette smoking. They also looked at pipes and cigars but did not have enough data on them. [Thus, although coffee consumption was associated with reductions in all-cause mortality], smoking seems to obliterate all the benefit you see from coffee and possibly other factors, and there could be no question that this is something we must focus on.

When they adjusted for these other factors, in fact, the more coffee you drank, it seemed, the lower the risk for all of these other conditions. For cancer, the risk was null; coffee had no impact at all on cancer risk. This is not completely surprising, based on the pancreatic cancer study I mentioned earlier, but it gives us some assurance that this particular lifestyle modification is not something that we need to pay attention to.

When we give patients advice about what they should and should not do, it is extremely important to focus on factors we can support rather than giving them too large a "menu." Of interest, all of the people who drank more than 6 cups of coffee a day had less college education, ate more red meat and less white meat, ate fewer fruits and vegetables, and had less vitamin supplementation and other supplements -- all the things we think aren't good for us.

Right now, I think coffee is off the [risk menu]. I am also very happy to say that this particular study was not sponsored by the coffee growers of America or the world, but rather by the NIH and AARP.

So, stay tuned. Another recent report says that coffee may actually delay or possibly prevent Alzheimer disease. We do not know whether tea would do this, we do not know whether other caffeinated beverages would, or whether it is an effect of caffeine. There are many, many elements in coffee, including antioxidants and other components, that could be responsible for this benefit.

This is something we will have to watch very, very closely. Thank you very much.


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