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 Stroke

Coffee may reduce the risk of ischemic stroke. A recent meta-analysis of 7 prospective studies with 442,098 participants, 6,962 stroke events, and follow-up of 2 to 24 years demonstrated that 1 to 3 cups of coffee were associated with a decreased risk of stroke (RR: 0.82, 95% CI: 0.74 to 0.90, p < 0.001). The evaluation of the risk of stroke in the general population consuming 3 to 6 cups of coffee per day showed a significant reduction (RR: 0.79, 95% CI: 0.68 to 0.92, p = 0.003). By contrast, habitual consumption of >6 cups of coffee per day was not associated with any effect on stroke risk (RR: 1.00, 95% CI: 0.76 to 1.32, p = 0.97). The authors concluded that coffee consumption is not associated with a higher risk of stroke and that habitual moderate consumption may exert a protective effect.[40]

In the Swedish Mammography Cohort, 34,670 women without a history of CV disease or cancer were followed for a mean of 10.4 years. The multivariable RRs of total stroke across categories of coffee consumption (<1 cup/day, 1 to 2 cups/day, 3 to 4 cups/day, and ≥5 cups/day) were 1.00, 0.78 (95% CI: 0.66 to 0.91), 0.75 (95% CI: 0.64 to 0.88), and 0.77 (95% CI: 0.63 to 0.92), respectively (p for trend = 0.02). The findings suggested that coffee consumption was associated with a statistically significant lower risk of stroke.[41] This inverse association of coffee consumption and mortality from stroke was also observed in a diabetic population (Fig. 5).[42] An analysis of a prospective group of >83,000 women from the Nurses' Health Study who were free of CV disease and cancer at baseline found that coffee consumption was associated with a modest but statistically significant reduction in the risk of stroke during the 24-year follow-up period.[43] Exactly how coffee lowers the risk of stroke is unknown, but postulated mechanisms include coffee's anti-inflammatory and insulin-sensitizing effects.[44–46]

Figure 5.

Coffee Intake in Diabetic Subjects
Adjusted hazard ratios of total, cardiovascular (CV) disease, coronary heart disease (CHD), and stroke mortality by volume of coffee consumption among subjects with type 2 diabetes mellitus. Error bars indicate 95% confidence interval (CI). Adapted from Bidel et al.42