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Meta-Analysis
. 2014 Feb 11;129(6):643-59.
doi: 10.1161/CIRCULATIONAHA.113.005925. Epub 2013 Nov 7.

Long-term coffee consumption and risk of cardiovascular disease: a systematic review and a dose-response meta-analysis of prospective cohort studies

Ming Ding  1 , Shilpa N Bhupathiraju, Ambika Satija, Rob M van Dam, Frank B Hu
Affiliations
Meta-Analysis

Long-term coffee consumption and risk of cardiovascular disease: a systematic review and a dose-response meta-analysis of prospective cohort studies

Ming Ding et al. Circulation. .

Abstract

Background: Considerable controversy exists on the association between coffee consumption and cardiovascular disease (CVD) risk. A meta-analysis was performed to assess the dose-response relationship of long-term coffee consumption with CVD risk.

Methods and results: PubMed and EMBASE were searched for prospective cohort studies of the relationship between coffee consumption and CVD risk, which included coronary heart disease, stroke, heart failure, and CVD mortality. Thirty-six studies were included with 1 279 804 participants and 36 352 CVD cases. 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, 0.87-1.03) for the highest category (median, 5 cups per day) category, 0.85 (95% confidence interval, 0.80-0.90) for the second highest category (median, 3.5 cups per day), and 0.89 (95% confidence interval, 0.84-0.94) for the third highest category (median, 1.5 cups per day). Looking at separate outcomes, coffee consumption was nonlinearly associated with both coronary heart disease (P for heterogeneity=0.001, P for trend <0.001, P for nonlinearity <0.001) and stroke (P for heterogeneity=0.07, P for trend <0.001, P for nonlinearity <0.001; P for trend differences >0.05) risks.

Conclusions: 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 to 5 cups per day, and heavy coffee consumption was not associated with elevated CVD risk.

Keywords: cardiovascular diseases; coffee; meta-analysis.

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Figures

Figure 1
Figure 1
Study selection process of coffee consumption and risk of CVD.
Figure 2
Figure 2
A. Forest plot of the association between third highest level of coffee consumption (median consumption: 1.5 cups/d) and risk of CVD compared to the lowest level (median consumption: 0 cup/d). The overall effect was obtained from a fixed-effects model that accounted for correlated outcomes. MI means myocardial infarction incidence; CVD means cardiovascular disease incidence; stroke means stroke incidence. B. Forest plot of the association between second highest level of coffee consumption (median consumption: 3.5 cups/d) and risk of CVD compared to the lowest level (median consumption: 0 cups/d). The overall effect was obtained from a fixed-effects model that accounted for correlated outcomes. MI means myocardial infarction incidence; CVD means cardiovascular disease incidence; stroke means stroke incidence. C. Forest plot of the association between highest level of coffee consumption (median consumption: 7 cups/d) and risk of CVD compared to the lowest level (median consumption: 0 cups/d). The overall effect was obtained from a fixed-effects model that accounted for correlated outcomes. MI means myocardial infarction incidence; CVD means cardiovascular disease incidence; stroke means stroke incidence.
Figure 2
Figure 2
A. Forest plot of the association between third highest level of coffee consumption (median consumption: 1.5 cups/d) and risk of CVD compared to the lowest level (median consumption: 0 cup/d). The overall effect was obtained from a fixed-effects model that accounted for correlated outcomes. MI means myocardial infarction incidence; CVD means cardiovascular disease incidence; stroke means stroke incidence. B. Forest plot of the association between second highest level of coffee consumption (median consumption: 3.5 cups/d) and risk of CVD compared to the lowest level (median consumption: 0 cups/d). The overall effect was obtained from a fixed-effects model that accounted for correlated outcomes. MI means myocardial infarction incidence; CVD means cardiovascular disease incidence; stroke means stroke incidence. C. Forest plot of the association between highest level of coffee consumption (median consumption: 7 cups/d) and risk of CVD compared to the lowest level (median consumption: 0 cups/d). The overall effect was obtained from a fixed-effects model that accounted for correlated outcomes. MI means myocardial infarction incidence; CVD means cardiovascular disease incidence; stroke means stroke incidence.
Figure 2
Figure 2
A. Forest plot of the association between third highest level of coffee consumption (median consumption: 1.5 cups/d) and risk of CVD compared to the lowest level (median consumption: 0 cup/d). The overall effect was obtained from a fixed-effects model that accounted for correlated outcomes. MI means myocardial infarction incidence; CVD means cardiovascular disease incidence; stroke means stroke incidence. B. Forest plot of the association between second highest level of coffee consumption (median consumption: 3.5 cups/d) and risk of CVD compared to the lowest level (median consumption: 0 cups/d). The overall effect was obtained from a fixed-effects model that accounted for correlated outcomes. MI means myocardial infarction incidence; CVD means cardiovascular disease incidence; stroke means stroke incidence. C. Forest plot of the association between highest level of coffee consumption (median consumption: 7 cups/d) and risk of CVD compared to the lowest level (median consumption: 0 cups/d). The overall effect was obtained from a fixed-effects model that accounted for correlated outcomes. MI means myocardial infarction incidence; CVD means cardiovascular disease incidence; stroke means stroke incidence.
Figure 3
Figure 3
Stratified analysis of the association between coffee consumption and risk of CVD. The included studies for the stratified analysis were the same as that for the dose response analysis. n was the number of comparisons for the highest level of coffee consumption. NOS score: the score using the Newcastle-Ottawa scale; specific dietary assessment method: diet that was assessed by 24h diet recall, diet record or food frequency questionnaire.
Figure 4
Figure 4
A. Coffee consumption and risk of CVD (n = 47). B. Coffee consumption and risk of CHD (n = 31). C. Coffee consumption and risk of stroke (n = 22). D. Dose response relationships of coffee consumption with risk of CVD. n was the number of comparisons.
Figure 4
Figure 4
A. Coffee consumption and risk of CVD (n = 47). B. Coffee consumption and risk of CHD (n = 31). C. Coffee consumption and risk of stroke (n = 22). D. Dose response relationships of coffee consumption with risk of CVD. n was the number of comparisons.
Figure 4
Figure 4
A. Coffee consumption and risk of CVD (n = 47). B. Coffee consumption and risk of CHD (n = 31). C. Coffee consumption and risk of stroke (n = 22). D. Dose response relationships of coffee consumption with risk of CVD. n was the number of comparisons.
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