Choosing the right morning drink may prove to be beneficial to your heart. Close to 50% of adults in the U.S. have 1 cup of coffee or more daily.1 Thus, determining the cardiovascular impact of such a widely consumed beverage could provide valuable insights into health-promoting behaviors. Findings from two large prospective studies recently published in the Annals of Internal Medicine show moderate consumption of coffee (> or equal to 3 cups) lowers all-cause mortality in diverse European and minority populations.2-3

In the European Prospective Investigation into Cancer and Nutrition (EPIC) trial, Gunter, et al.2 investigated the association of coffee consumption with all-cause and cause-specific mortality. When compared to nonconsumers, men who consumed 3 or more cups of coffee daily had significantly lower all-cause (HR = 0.88; 95% CI, 0.82-0.95) and digestive-disease mortality (HR = 0.41; 95% CI, 0.32-0.54). Women demonstrate similar inverse associations, both for lower all-cause (HR = 0.93; 95% CI, 0.87-0.98) and digestive-disease mortality (HR = 0.6; 95% CI, 0.46-0.78). There was an added benefit of reduced circulatory  (HR = 0.78; 95% CI, 0.68-0.9) and cerebrovascular-disease mortality (HR= 0.7; 95% CI, 0.55-0.9) with a positive association with ovarian-cancer mortality (HR = 1.31; 95% CI, 1.07-1.61). Among women in the EPIC Biomarkers sub cohort, high consumers were associated with lower C-reactive protein, lipoprotein (a) and glycated hemoglobin levels; in men, high consumers were associated with lower serum alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase and γ-glutamyltransferase with no observable cardiovascular benefit.

Similar findings were observed among nonwhite populations. In the Multiethnic Cohort (MEC), a large prospective population-based cohort of African American, Japanese American, Latino and Caucasian coffee high-consumers were associated with lower total mortality (1 cup a day: HR 0.88 [95% CI, 0.85to 0.91]; from 2 to 3 cups a day: HR 0.82 [CI, 0.79 to 0.86]; ≥ 4 cups a day: HR 0.82 [CI 0.78 to 0.87] ; P for trend <0.001), irrespective of caffeine content (caffeinated/decaffeinated).3 Cause- specific endpoints demonstrating inverse associations were diabetes, cancer, heart, kidney and respiratory disease. Native Hawaiian Americans did not approach statistical significance.3

Other studies have established the protective effects of consuming from 1 to 3 cups of coffee a day for cardiovascular risk factors. These include lowering systolic (OR = 0.45; 95% CI 0.26-0.78) diastolic blood pressure (OR = 0.44; 95% CI 0.20-0.98)4-5 and hyperhomocysteinemia (OR = 0.29; 95% CI 0.11-0.78)4 as well as reduced mortality risk post-acute myocardial infarction.6

The investigators caution that, while the influences of the phytochemical bioactive components of coffee have evidenced favorable, protective overtones and reduced mortality (irrespective of caffeine content), further investigation is needed. However, in the absence of contraindications due to other health concerns, moderate coffee consumption can be safe, offering benefit to individuals without harmful effects on health outcomes. Healthcare providers should use clinical judgment and provide patient-centered discussion before recommending coffee intake of from 3 to 5 cups a day (nearly 400 mg/d), but should feel certain no additional harm will result from moderate daily consumption. It should be noted since these are observational studies, it is impossible to comment on causation. Particularly since caffeine has a profound effect on energy, gasterointestinal, heart rate, and neurological status individuals with sensitivity may have self-selected out of consumption.

It should be noted that the beneficial effects of moderate coffee consumption do not extend to popular sugarsweetened forms of coffee such as lattés, frappuccinos, etc. These forms of coffee promote deleterious health outcomes and are linked to weight gain, diabetes, cavities, heart disease and hypertension.7      

Disclosure statement: Dr. Hill transitioned  to a full- time faculty appointment for Sanofi in the diabetes division after this article was written. Dr. Elkins has no disclosures to report.

References:

1. Loftfield E, Freedman ND, Dodd KW, et al. Coffee drinking is widespread in the United States, but usual intake varies by key demographic and lifestyle factors. J Nutr. 2016 Sep;146(9):1762-8. doi: 10.3945/jn.116.233940. Epub 2016 Aug 3.
2. Gunter MJ, Murphy N, Cross AJ, et al. Coffee drinking and mortality in 10 European countries: A multinational cohort study. Ann Intern Med. 2017 Jul 11. doi: 10.7326/M16-2945. [Epub ahead of print.]
3. Park SY, Freedman ND, Haiman CA, Le Marchand L, Wilkens LR, Setiawan VW. Association of coffee consumption with total and cause-specific mortality among nonwhite populations. Ann Intern Med. 2017 Jul 11. doi: 10.7326/M16-2472. [Epub ahead of print] PMID: 28693036.
4. Miranda AM, Steluti J, Fisberg RM, Marchioni DM. Association between coffee consumption and its polyphenols with cardiovascular risk factors: A population-based study. Nutrients. 2017 Mar 14;9(3). pii: E276. doi: 10.3390/nu9030276. PMID: 28335422
5. Mesas AE, Leon-Muñoz LM, Rodriguez-Artalejo F, Lopez-Garcia E. The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and meta-analysis. Am J Clin Nutr. 2011 Oct;94(4):1113-26. doi: 10.3945/ajcn.111.016667. Epub 2011 Aug 31. Review.PMID: 21880846
6. Brown OI, Allgar V, Wong KY. Coffee reduces the risk of death after acute myocardial infarction: a meta-analysis. Coron Artery Dis. 2016 Nov;27(7):566-72. doi: 10.1097/MCA.0000000000000397.
7. Park S, Lundeen EA, Pan L, Blanck HM. Impact of knowledge of health conditions on sugar-sweetened beverage intake varies among U.S. adults. Am J Health Promot. 2017 Jan 1. Doi: 10/1177/0890117117717381 [Epub ahead of print.]