Espresso Coffee Associated With Increased Total Cholesterol

Ashley Lyles

May 11, 2022

Espresso consumption is associated with higher total cholesterol levels, a population-based, cross-sectional study suggests.

Elevations in serum total cholesterol level were significantly linked to espresso consumption, particularly in men, report Åsne Lirhus Svatun, of the the Arctic University of Norway, in Tromsø, Norway, and colleagues.

Drinking boiled/plunger coffee was associated with significantly higher serum total cholesterol levels in women and men. There was a significant relationship between filtered coffee consumption and total cholesterol, but only among women, the researchers report.

"Doctors could become mindful of asking about coffee consumption when taking up the history of patients with elevated serum cholesterol," said study author Maja-Lisa Løchen, MD, PhD, of the the Arctic University of Norway, in an email.

"Guiding patients to change from plunger coffee or other unfiltered coffee types to filtered or instant coffee could be a part of a lifestyle intervention to lower serum cholesterol levels."

The results were published online May 10 in the journal Open Heart.

Previous studies of the relationship between serum cholesterol and espresso have had varying outcomes, the researchers note.

Given that coffee consumption is high worldwide, even slight health effects can have substantial health consequences, the researchers note. "Coffee was included for the first time in the 2021 ESC [European Society of Cardiology] Guidelines on cardiovascular disease prevention in clinical practice," they write. "Increased knowledge on espresso coffee's association with serum cholesterol will improve the recommendations regarding coffee consumption."

"I don't think that the findings in this paper are necessarily enough to change any advice about coffee," said David Kao, MD, an associate professor medicine at the University of Colorado Anschutz Medical Campus in Denver, in commenting on the findings. "This is partly because the most important thing at the end of the day is whether subsequent events like heart attack or stroke increased or decreased. This analysis was not designed to answer that question," he said.

"If one has to choose between this study, which would suggest to drink less coffee to maintain low cholesterol, and the others, which would suggest increasing coffee consumption might reduce risk of multiple kinds of CVD, one should choose the latter," Kao concluded.

In the current study, the investigators assessed 21,083 participants in the Tromsø Study in Northern Norway. The mean age of the participants was 56.4 years. Using multivariable linear regression, the researchers compared the relationship between each level of coffee consumption with no coffee consumption as the reference point and serum total cholesterol as the dependent variable. They tested for sex differences and adjusted for relevant covariates.

The findings indicate that drinking three to five cups of espresso each day was significantly linked with greater serum total cholesterol by 0.16 mmol/L (95% CI, 0.07 – 0.24) for men and by 0.09 mmol/L (95% CI, 0.01 – 0.17) for women in comparison with participants who did not drink espresso daily.

Compared with individuals who did not drink plunger/boiled coffee, consumption of six or more cups of plunger/boiled coffee each day was linked with elevated serum total cholesterol levels by 0.23 mmol/L (95% CI, 0.08 – 0.38) for men and 0.30 mmol/L (95% CI, 0.13 – 0.48) for women.

Notably, for women but not men, there was an increase in serum total cholesterol of 0.11 mmol/L (95% CI, 0.03 – 0.19) in association with drinking six or more cups of filtered coffee per day.

When excluding participants who did not drink instant coffee, drinking instant coffee yielded a significant linear pattern for both men and women, but there was not a dose-dependent association.

These data show that sex differences were significant for every coffee type except plunger/boiled coffee, the authors note.

Limitations of the study include its cross-sectional design; lack of generalizability of the data, given that the cohort primarily consisted of elderly adults and middle-aged White persons; and the fact that the study did not adjust for all confounding variables, the researchers note.

Also among the study's limitations were that some data were self-reported, and the missing indicator approach was implemented to assess data, the authors add.

Future research efforts should focus on following this cohort over many years to determine how consumption of various types of coffee is linked with events such as heart failure, stroke, and myocardial infarction. This insight would be important in offering guidance on whether the style of coffee preparation matters, concluded Kao.

The study was supported by a number of sources, including the Arctic University of Norway and the Northern Norway Regional Health Authority. Svatun and Løchen report no relevant financial relationships.

Open Heart. Published online May 10, 2022. Full text

Ashley Lyles is an award-winning medical journalist. She is a graduate of New York University's Science, Health, and Environmental Reporting Program. Her work has appeared in outlets such as The New York Times Daily 360, PBS NewsHour, The Huffington Post, Undark, The Root, Psychology Today, Insider, and Tonic (Health by Vice), among other publications.

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