Wine, Chocolate, and Coffee: Forbidden Joys?

Thomas F. Lüscher


Eur Heart J. 2021;42(44):4520-4522. 

In This Article


The goat herder Kaldi, so the legend goes, discovered coffee beans in ancient Ethiopia when after eating berries from a certain tree, his goats became so energetic that they did not want to sleep at night. Even today, a coffee in the morning is a must for most of us to get going; and indeed, it stimulates the sympathetic nervous system and causes palpitations and increases blood pressure in those not used to it.[12] Unlike virgin drinkers, habitual drinkers are protected from the stimulatory cardiovascular effects of coffee due to down-regulation of the sympathetic response. Surprisingly, this effect of coffee is independent of caffeine und due to another ingredient(s) that remain to be discovered.

Furthermore, coffee enhances the cardiovascular response to mental stress in nonhabitual coffee drinkers, with an additional increase in systolic BP, whereas in habitual drinkers, the response is blunted (Graphical Abstract). Caffeine alone does not exert any potentiating effect, confirming that again ingredient(s) other than caffeine are at least partially responsible. In line with this observation, moderate coffee consumption is inversely associated with the risk of heart failure, with the largest effect with 4 servings per day, recently confirmed in a machine learning analysis of several registries.[13] Most likely, moderate coffee drinking attenuates the massive sympathetic activation in heart failure and as such provides some protection. In a large registry involving 42 659 participants of the European Prospective Investigation into Cancer and Nutrition (EPIC)–Germany study, coffee consumption during 9 years of follow-up, did not affect the overall risk of chronic disease. However, both caffeinated and decaffeinated coffee consumption (4 vs. <1 cup/day) was associated with a lower risk of Type 2 diabetes.[14] A large NIH study found coffee consumption inversely associated with mortality, specifically with 4 or 5 cups/day for heart and respiratory disease, stroke, injuries and accidents, diabetes, and infections, but not cancer.[15]