Long-Term Coffee Consumption and Risk of Cardiovascular Disease

A Systematic Review and a DoseResponse MetaAnalysis of Prospective Cohort Studies

Ming Ding, MS; Shilpa N. Bhupathiraju, PhD; Ambika Satija, BA; Rob M. van Dam, PhD; Frank B. Hu, MD, PhD

Introduction

 Coffee is one of the most widely consumed beverages around the world. coffee consumption VS chronic disease = important public health implications. 1960s, 1980s, 2000s To examine the doseresponse association of coffee consumption with CVD risk, we conducted a systematic review and metaanalysis of coffee consumption and incidence of total CVD outcomes.

Methods & Results

Characteristics of Studies
Excluding criteria: - Retrospective - No standard errors - outcomes: Af, H/T, venous thrombus - no confounders was adjusted for Including criteria: - Prospective - exposure: coffee, includes decaffeinated - outcomes: CVD including CHD, stroke, heart failure, mortality PubMed and EMBASE were searched for prospective cohort studies (coffee consumption and CVD risk) - btw JAN 1966 and MAR 2013 - coffee, CVD, coronary heart disease, stroke, mortality, heart failure, MI, IHD, sudden cardiac arrest, and ACS 2587 potentially relevant citations
1,283,685 participants and 47,779 CVD cases, Including 28,347 CHD cases 12,030 stroke cases 7402 other CVD cases

36 studies 1. follow-up:6-44 yrs (median 10 yrs) Remained 2. 21:Europe, 12:US, 3:Japan In meta-analysis

0.89

Risk of CVD for median consumption 1.5 cups/day VS 0 cup/day

0.85

Risk of CVD for median consumption 3.5 cups/day VS 0 cup/day

0.95

Risk of CVD for median consumption 5.5 cups/day VS 0 cup/day

Discussion

Key Point 1
nonlinear association between coffee consumption and risk of CVD
Moderate coffee consumption (35 cups per day) was associated with lower CVD risk Heavy coffee consumption (6 cups per day) was neither associated with a higher nor a lower risk of CVD

Key Point 2
Previous meta-analysis found no association between moderate coffee consumption and CHD risk in the overall population
without adjustment for confounders, which might have biased the RRs upward because of confounding by factors such as smoking.

Key Point 3
Liu et al found that 4 cups per day of coffee consumption was associated with increased mortality for participants <55 years of age.
small size, lack of updated dietary assessment

Key Point 4
U-shaped association between coffee consumption and CVD risk observed
A) individuals with hypertension or other conditions related to CVD risk might have changed their coffee consumption. However, we observed no significant difference. B) Heavy coffee consumption was associated with higher risk of CVD, but this is likely due to confounding by smoking. After adjustment, heavy coffee consumption was not significantly associated with CVD.

 Coffee is a complex chemical mixture the phenolic compound chlorogenic acid, caffeine, minerals such as potassium and magnesium, niacin and its precursor trigonelline, and lignans.
associated with higher insulin sensitivity, lower risk of DM, and lower concentrations of inflammatory markers such as CRP and E-selectin. Short-term: caffeine can acutely increase BP and could acutely affect arterial stiffness and endothelium-dependent vasodilation adversely. Long-term: elevated risk of hypertension and a higher level of plasma homocysteine. cafestol in unfiltered coffee increases serum total cholesterol

 C) The nonlinear U-shaped relationship between coffee consumption and risk of CVD might be due to a combination of beneficial and detrimental effects:
For moderate coffee consumption, beneficial effects may be greater than adverse effects, whereas for heavy consumption, detrimental effects may counterbalance beneficial effects.

Key Point 5
No significant association between decaffeinated coffee consumption with CVD risk
consumption of decaffeinated coffee was much lower than caffeinated coffee, diminishing the power to detect reverse causation problem in that individuals with hypertension or other CVD-related conditions might switch from regular coffee to decaffeinated coffee

Key Point 6
Cornelis et al showed that the CYP1A2 genotype was an effect modifier between coffee consumption and risk of myocardial infarction
Coffee consumption = higher risk of MI for the slow metabolizer not related to MI risk for fast metabolizer Only a case-control study that have not yet been replicated in prospective cohort studies

Key Point 7
Our metaanalysis included 35 cohort studies and 1,283,685 participants. Prospective + differential misclassification of coffee consumption = minimized recall bias + selection bias both semiparametric and parametric methods, and both analyses indicated a Ushaped relationship between coffee consumption and CVD risk.

Key Point 8
Given the observational nature of the studies, the possibility of residual confounding cannot be excluded.
However, because higher consumption associated with a less healthy lifestyle (cigarette smoking, less physical activity, less healthy diet), the observed association between moderate coffee consumption and a lower CVD risk is unlikely to be explained

Results may not apply to unfiltered coffee (eg, French press, Scandinavian boiled, or Turkish/Greek coffee).

Conclusion
Our meta-analysis suggests a nonlinear relationship between coffee consumption and CVD risk. Moderate coffee consumption was associated with lower CVD risk, with the lowest CVD risk at 3 to 5 cups per day of coffee consumption. heavy coffee consumption was not associated with CVD risk. This nonlinear association with coffee consumption was for both CHD and stroke.

Clinical Perspective
Coffee is one of the most widely consumed beverages around the world, and its association with cardiovascular disease has been investigated in numerous epidemiological studies. A key issue that remains to be resolved is the doseresponse relationship of longterm coffee consumption with cardiovascular disease (CVD) risk.

 In the current meta-analysis, we found a nonlinear relationship of coffee consumption with CVD risk: Moderate coffee consumption was associated with lower risk of CVD, with the lowest CVD risk at 3 to 5 cups per day, and heavy coffee consumption was not associated with risk of CVD.

 The present study provides strong evidence that

long-term heavy consumption of coffee is not associated with CVD risk provides insight into the potential mechanism of the nonlinear relationship between coffee consumption and CVD risk

Thank you