Effects of Habitual Coffee Consumption on Cardiometabolic Disease, Cardiovascular Health, and All-Cause Mortality

James H. O'Keefe, MD; Salman K. Bhatti, MD; Harshal R. Patil, MD; James J. DiNicolantonio, PHARMD; Sean C. Lucan, MD, MPH, MS; Carl J. Lavie, MD


J Am Coll Cardiol. 2013;62(12):1043-1051. 

In This Article

Coffee and CHD

Decades-old studies suggested coffee consumption might cause adverse CV effects including an increased risk of myocardial infarction (MI).[22,23] However, unmeasured confounding probably flawed those early studies; in subsequent analyses when other important health-related variables (such as smoking, alcohol use, saturated fat consumption, physical activity, and body mass index) were adjusted for, the risk of mortality, both all-cause and CV related, appeared to be lower in regular coffee drinkers (Figs. 2A and 2B).[24,25]

Figure 2.

Adjusted Hazard Ratios for Risk of Death as a Function of Coffee Consumption
Association of daily coffee consumption with total and heart disease mortality among men (A) and women (B). Error bars indicate 95% confidence interval. Adapted from Freedman et al.25

Many epidemiological studies have evaluated the potential effects of coffee on CHD, and these individual studies have generally shown neutral effects. However, a meta-analysis of 21 independent prospective cohort studies from January 1966 to January 2008 suggested that moderate coffee consumption may decrease the long-term risk of CHD.[26] In this study, 15,599 CHD cases developed in 407,806 participants. Compared with the light-to-absent coffee consumption (<1 cup/day in the United States or ≤2 cups/day in Europe), moderate coffee consumption (>1 or 2 cups daily, respectively) was associated with significantly lower rates of CHD in the entire group of men and women with an RR of 0.87 (p = 0.001).

Several studies have suggested that it is safe for patients with established CHD to continue their habitual coffee consumption. An RCT involving 103 patients with acute ST-segment elevation MI evaluated the effect of acute ingestion (immediate effects) of coffee on autonomic function and CV health. Coffee ingestion was associated with an increase in parasympathetic tone, and coffee did not increase cardiac arrhythmia. The authors concluded that coffee ingestion is safe and not associated with adverse CV outcomes in post-MI patients.[27] A more recent study showed that acute caffeine ingestion significantly decreased high-sensitivity C-reactive protein levels in 2 groups of patients with and without CHD compared with placebo.[28]