Can coffee consumption reduce the risk of CVD mortality?

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Expert comment from António Vaz Carneiro,MD, PhD, FACP University of Lisbon School of Medicine

Each year cardiovascular disease (CVD) causes around 4 million deaths in Europe1, and is projected to remain the single leading cause of death, with almost 23.6 million people expected to die from CVD by 20302. However, improvements in medical interventions as well as significant developments in preventative aspects of care have succeeded in reducing the risk of CVD mortality. With this in mind, it is important to explore and acknowledge factors which might have a protective effect to continue to make strides in reducing CVD mortality.

At this year’s European Association for Cardiovascular Prevention & Rehabilitation congress in Lisbon, Portugal, eminent cardiovascular experts gathered to discuss the latest research in CVD aetiology, prevention, treatment and care, and it was my pleasure to chair the Institute for Scientific Information on Coffee’s Satellite Symposium on the subject of ‘Coffee and CVD Mortality’.

Leading researchers in this field presented on the role of lifestyle factors in CVD mortality risk reduction, the epidemiological evidence on coffee and CVD mortality, and the conclusions from meta-analyses on coffee and CVD mortality.

  • Esther Lopez-Garcia, Associate Professor, Universidad Autonoma in Madrid
  • Alicja Wolk, Professor of Nutritional Epidemiology, Karolinska Institute
  • Carlo La Vecchia, Chief of Epidemiology, Mario Negri Institute

The Symposium was a valuable addition to the programme, and provided a unique opportunity to highlight and consider recent research which has shown an association between moderate coffee consumption and a reduced risk of CVD mortality.

The potential role of lifestyle factors in CVD mortality risk reduction was highlighted through research such as The Global Burden of Disease Study 2013, which suggests that changes in lifestyle and improvements in healthcare can help to control the negative impact that demographic changes could have on CVD mortality rates. Additional research confirms the importance of lifestyle factors in preventing cardiovascular events. A Swedish study has shown that in males, a combination of 5 healthy behaviours (a healthy diet, moderate alcohol consumption (10 to 30 g/ day), no smoking, being physically active and having no abdominal adiposity) could prevent 79% of myocardial infarction events, although all factors were only present in 1% of participants3. In women, a US study suggests that half of CVD cases could be avoided by modifying lifestyle choices, as approximately 73% of coronary heart disease cases and 46% of clinical CVD were attributable to an unhealthy lifestyle4.

The protective effect of coffee against CVD mortality was then explored in more detail. A 2013 review of seventeen studies on coffee consumption and mortality was presented, revealing that intake of coffee at 3-5 cups per day showed the most significant protective effect, whilst quantities over 5 cups per day were associated with a smaller reduction in total mortality5. Variability regarding the optimal level of coffee consumption across differing countries was noted, for instance results from Japan suggest an inverse, i.e. favourable, association at 2 cups of coffee per day, whilst studies from Europe and the US showed an inverse association at approximately 3 cups per day.

One area of research that I found particularly intriguing was the statistically significant negative association between coffee consumption and subsequent risk of type 2 diabetes, and how this may be related to coffee’s suggested protective effect against CVD mortality; people with diabetes typically have a higher CVD mortality risk therefore coffee may be particularly beneficial6.

Although the precise mechanism of action behind the suggested inverse, i.e. favourable association between coffee consumption and CVD mortality risk is not known, a number of theories are proposed including coffee’s anti-inflammatory properties, caffeine (although the benefit is also seen with decaffeinated beverages), and/or further compounds found within coffee including antioxidants. I look forward to further research which continues to explore this in depth.

References

  1. European Cardiovascular Disease Statistics 2012, European Heart Network, Brussel http://www.ehnheart.org/cvd-statistics.html%20
  2. World Health Organization http://www.who.int/mediacentre/factsheets/fs317/en/index.html
  3. Akesson A. et al. (2014) Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men – A Population-Based Prospective Cohort Study. J Am Coll Cardiol. 64(13):1299-1306
  4. Chomistek A.K. et al. (2015) Healthy lifestyle in the primordial prevention of cardiovascular disease among young women. J Am Coll Cardiol. 65(1):43-51
  5. Malerba S. et al. (2013) A meta-analysis of prospective studies of coffee consumption and mortality for all causes, cancers and cardiovascular disease. European Journal of Epidemiology. 28(7):527-39
  6. Huxley R. et al. (2009) Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus: a systematic review with meta-analysis. Arch Intern Med. 169(22):2053-63

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