With increasing public awareness on cardiovascular disease (CVD) prevention, significant interest has focused on modifiable lifestyle risk factors, including the safety of coffee.
Coffee is ubiquitous in most societies, with its main constituent caffeine the most commonly consumed psychostimulant worldwide.
Historically up to 80% of health practitioners recommend avoiding coffee in patients with CVD. This misconception has been challenged by recent observational studies, which not only report the safety but a beneficial effect of coffee intake on incident arrhythmia and CVD prevention. In fact, coffee consumption at 3–4 cups/day is described as moderately beneficial in the prevention of CVD in the 2021 European Society of Cardiology guidelines, although no such recommendation was made in the 2019 AHA/ACC guidelines.
Although observational studies support the beneficial health effects of coffee, there is a lack of dedicated studies aiming to address the impact of different coffee subtypes on hard clinical outcomes such as arrhythmia, CVD, and mortality. Much attention is directed towards coffee’s major constituent, caffeine; however, coffee is made up of more than 100 different biologic agents.
Drinking two to three cups of coffee a day is linked with a longer lifespan and lower risk of cardiovascular disease
Professor Peter Kistler of the Baker Heart and Diabetes Research Institute, Melbourne, Australia and his team, examined the associations between types of coffee and incident arrhythmias, cardiovascular disease and death using data from the UK Biobank, which recruited adults between 40 and 69 years of age. Cardiovascular disease was comprised of coronary heart disease, congestive heart failure and ischaemic stroke.
The study included 449,563 participants free of arrhythmias or other cardiovascular disease at baseline. The median age was 58 years and 55.3% were women. Participants completed a questionnaire asking how many cups of coffee they drank each day.
They were then grouped into six daily intake categories, consisting of none, less than one, one, two to three, four to five, and more than five cups per day. The usual coffee type was instant in 198,062 (44.1%) participants, ground in 82,575 (18.4%), and decaffeinated in 68,416 (15.2%). There were 100,510 (22.4%) non-coffee drinkers who served as the comparator group.
Coffee drinkers were compared to non-drinkers for the incidence of arrhythmias, cardiovascular disease and death, after adjusting for age, sex, ethnicity, obesity, high blood pressure, diabetes, obstructive sleep apnoea, smoking status, and tea and alcohol consumption. Outcome information was obtained from medical records and death records. The median follow up was 12.5 years.
All types of coffee were linked with a reduction in death from any cause. The greatest risk reduction seen with two to three cups per day, which compared to no coffee drinking was associated with a 14%, 27% and 11% lower likelihood of death for decaffeinated, ground, and instant preparations, respectively.
All coffee subtypes were associated with a reduction in incident cardiovascular disease. Again, the lowest risk was observed with two to three cups a day, which compared to abstinence from coffee was associated with a 6%, 20%, and 9% reduced likelihood of cardiovascular disease for decaffeinated, ground, instant coffee, respectively.
Ground and instant coffee, but not decaffeinated, was associated with a reduction in arrhythmias including atrial fibrillation. Compared with non-drinkers, the lowest risks were observed with four to five cups a day for ground coffee and two to three cups a day for instant coffee, with 17% and 12% reduced risks, respectively.
As we can see, these findings indicate that drinking modest amounts of coffee of all types should not be discouraged but can be enjoyed as a heart healthy behavior. Decaffeinated, ground, and instant coffee, particularly at 2–3 cups/day, were associated with significant reductions in incident CVD and mortality. Ground and instant but not decaffeinated coffee was associated with reduced arrhythmia.
David Chieng, Rodrigo Canovas, Louise Segan, Hariharan Sugumar, Aleksandr Voskoboinik, Sandeep Prabhu, Liang Han Ling, Geoffrey Lee, Joseph B Morton, David M Kaye, Jonathan M Kalman, Peter M Kistler, (September 27, 2022). The impact of coffee subtypes on incident cardiovascular disease, arrhythmias, and mortality: long-term outcomes from the UK Biobank. European Journal of Preventive Cardiology. Retrieved from : https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwac189/6704995
Photo by Clay Banks on Unsplash