Long-Term Coffee Consumption and Risk of Cardiovascular Disease: A Systematic Review and a Dose–Response Meta-Analysis of Prospective Cohort Studies

Study Questions:

Is long-term coffee consumption associated with increased risk for cardiovascular disease (CVD)?


Prospective studies were identified through a search of PubMed and EMBASE published between January 1966 and March 2013. Studies were included if they were prospective cohorts, with data on coffee consumption including total coffee, caffeinated coffee, or decaffeinated coffee. The outcome of interest had to include CVD including heart disease, stroke, heart failure, and/or CVD mortality. Studies were excluded if they had a retrospective design; the estimates were presented without standard errors or other information that allowed calculation of standard errors; the outcome was atrial fibrillation, atherosclerosis, hypertension, aortic stiffness, or venous thrombus; or no confounders were adjusted for.


A total of 36 studies were included, with 1,279,804 subjects and 36,352 CVD cases. Duration of follow-up for incident CVD ranged from 6-44 years, with a median follow-up of 10 years. Twenty-one studies were conducted in Europe, 12 in the United States, and three in Japan. A nonlinear relationship of coffee consumption with CVD risk was identified (p for heterogeneity = 0.09, p for trend < 0.001, p for nonlinearity < 0.001). Compared with the lowest category of coffee consumption (median, 0 cups per day), the relative risk of CVD was 0.95 (95% confidence interval [CI], 0.87-1.03) for the highest category (median, 5 cups per day), 0.85 (95% CI, 0.80-0.90) for the second highest category (median, 3.5 cups per day), and 0.89 (95% CI, 0.84-0.94) for the third highest category (median, 1.5 cups per day). Coffee consumption was nonlinearly associated with both coronary heart disease and stroke risks.


The investigators concluded that a nonlinear association between coffee consumption and CVD risk was observed in this meta-analysis. Moderate coffee consumption was inversely significantly associated with CVD risk, with the lowest CVD risk at 3-5 cups per day, and heavy coffee consumption was not associated with elevated CVD risk.


Often patients are concerned about their coffee intake and potential risk for CVD. This analysis suggests that there is no increased risk related to moderate or even heavy coffee consumption.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Japan, Heart Diseases, Risk, Stroke, Heart Failure, Coronary Disease, Europe, United States, Coffee

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