Coffee intake inversely tied to HF risk

An analysis of three large epidemiological studies revealed an inverse association between coffee consumption and risk of heart failure (HF).

“We investigated the diet domain in FHS, CHS, and the ARIC* study to identify potential lifestyle and behavioural factors associated with coronary heart disease, HF, and stroke,” said the researchers. Establishing the role of these factors may enhance understanding of HF risk, risk assessment, and adherence to lifestyle/behavioural therapies and cardiovascular disease (CVD) prevention guidelines. [Circulation 2014;129(25 Suppl 2):S49-S73]

“[W]e identified multiple dietary and behavioural risk factors for CVD outcomes including … red meat, whole milk, and coffee consumption. Among these dietary variables … increased coffee consumption appeared to correlate with reduced risk of developing HF later in life,” they continued.

This was observed on univariate analysis in both CHS (hazard ratio [HR], 0.86 per cup/day; p=0.005) and ARIC (HR, 0.98 per cup/day; p=0.048). In CHS, the association remained significant after adjusting for FHS risk scores (HR, 0.88 per cup/day; p=0.01). In ARIC, multivariate analysis revealed a trend towards an association between increased coffee intake and HF risk (HR, 0.98 per cup/day; p=0.06). [Circ Heart Fail 2021;doi:10.1161/CIRCHEARTFAILURE.119.006799]

On Cox proportional hazards analysis, among all risk factors evaluated, increased coffee intake was the only factor that remained significantly associated with reduced HF risk (HR, 0.95 per cup/day; p=0.02), which was sustained even after adjusting for FHS CVD risk score (HR, 0.95 per cup/day; p=0.03).

Caffeine, decaf effects

An inverse association was also observed between caffeine intake (ie, one cup coffee or two cups black tea) and HF risk across all three studies on multivariate analysis (HR [per 100 mg], 0.92; p=0.01, HR, 0.97; p=0.07, and HR, 0.99; p=0.049 for FHS, CHS, and ARIC, respectively). This association underpins the role of caffeine in this setting regardless of its source, noted the researchers.

Conversely, multivariate analysis revealed an increased HF risk tied to decaf coffee intake in FHS (HR, 1.10 per cup/day; p=0.004). However, this may have been confounded by other CVD risk factors, switching from regular to decaf coffee, smoking, and the additives involved in the decaffeination process. [Circulation 2014;129:643-659; Hypertension 1989;14:563-569; Crit Rev Food Sci Nutr 1999;39:441-456]

Coffee intake: to increase or not?

FHS, CHS, and ARIC (n=5,209, 5,888, and 15,792, respectively) are community-based studies designed to investigate the frequency, survival rate, and determinants of CVD, with multiple endpoints and long-term follow-up (at least 10 years).

“At a minimum, the current study appears to offer additional reassurance for those of us partial to a caffeinated cup of coffee that this beverage choice is unlikely to result in long-term CV harm,” commented Dr Amanda Vest from Tufts Medical Center, Boston, Massachusetts, US, in a separate editorial. [Circ Heart Fail 2021;doi:10.1161/CIRCHEARTFAILURE.121.008297]

“[However,] intentional or prescribed increase in coffee intake for the purposes of reducing HF risk cannot be recommended based on our results,” the researchers stressed. “[C]offee consumption [may be] a marker or proxy for another behaviour or dietary factor that reduces HF risk.”

“[Given] the pervasive consumption of coffee in modern society and the high potential for dietary modification that could reduce HF risk … further exploration of [its role in HF development] is warranted,” they continued, specifically recommending a prospective randomized or cohort control trial that would substantiate the findings and potentially establish causality.

Future trials may also shed light on other factors that might have introduced information bias, noted the researchers and Tufts. “[S]erving sizes, caffeine content, methods of roasting and grinding, timing of consumption, and the presence of additives such as sugar and dairy products could all influence the effect of coffee on the CV system,” said Tufts.