Coffee consumption and risk of coronary heart disease: A meta-analysis

https://doi.org/10.1016/j.numecd.2006.07.013Get rights and content

Abstract

Background and aims

During the past three decades the relationship between habitual coffee drinking and coronary heart disease (CHD) has been assessed in numerous studies, with conflicting results. The aim of this study was to systematically examine the data published on the association between habitual coffee consumption and risk of CHD.

Methods and results

Thirteen case–control and 10 cohort studies were included. Case–control studies incorporated 9487 cases of CHD and 27,747 controls, and cohort studies included a total of 403,631 participants that were followed for between 3 and 44 years. The summary of odds ratios (OR) for the case–control studies showed statistically significant associations between coffee consumption and CHD for the highest intake group (>4 cups/day), OR 1.83 (95% CI 1.49–2.24; P < 0.0001), and for the second highest category (3–4 cups/day), OR 1.33 (95% CI 1.04–1.71; P < 0.0001), while no significant association emerged for low daily coffee intake (≤2 cups/day), OR 1.03 (95% CI 0.87–1.21; P = 0.45). The analysis of long-term follow-up cohort studies did not show any association between the consumption of coffee and CHD, with a relative risk (RR) of 1.16 (95% CI 0.95–1.41; P = 0.14) for the highest category, and 1.05 (95% CI 0.90–1.22; P = 0.57) and 1.04 (95% CI 0.90–1.19; P = 0.60) for the second and third highest categories, respectively. These results did not differ substantially when controlling for region of origin, fatal and non-fatal events, year of publication, and number of years of follow-up.

Conclusions

Despite a significant association between high consumption of coffee and CHD reported among case–control studies, no significant association between daily coffee consumption and CHD emerged from long-term follow-up prospective cohort studies.

Introduction

Coffee is one of the most widely consumed beverages in the world. Since early 1970s, coffee consumption has attracted interest as a potential health hazard due to the positive association with coronary heart disease (CHD) reported in a number of case–control and cohort studies [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. However, in contrast with these results, other case–control and cohort studies performed in different population groups showed negative results, perhaps indicating that in some of the previous studies the strong association reported between coffee consumption and CHD resulted from inappropriate statistical analysis, i.e. lack of adjustment for possible confounders [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28].

To date, the question whether coffee drinking increases the risk of CHD continues to be controversial. Meta-analyses of the association between coffee consumption and CHD carried out in the 1990s reported conflicting results within the different types of studies analysed, as shown by the positive association with CHD found among case–control but not among cohort studies. In 1992, Myers and Babinski carried out a meta-analysis of cohort prospective studies and reported no influence of coffee on CHD [29]; whereas in 1993, Greenland reported a positive association with CHD among case–control studies, but not among prospective cohort studies [30]. The latter association is supported by the most recent analysis conducted in 1994 by Kawachi et al., which showed an increased risk of CHD with consumption of five cups of coffee per day, but only among case–control studies [31].

Currently, the influence of coffee on the health of people, is considered of great significance due to the enormous consumption worldwide. However, analysing the occurrence of disease in relation to intake of coffee is difficult, mainly due to the complexities that arise when trying to define a coffee beverage. Coffee, as a beverage made from the extract of coffee beans, is available in a remarkable variety of different types throughout the world, in terms of brewing method and caffeine content; even within the same country methods of preparation and drinking preferences differ significantly. This could partly explain the contrasting results reported in the literature. Hence, we decided to conduct a systematic review with meta-analysis of the available epidemiological studies, both case–control and prospective, in order to evaluate if habitual coffee consumption is associated with an increased risk of CHD.

Section snippets

Study selection

We conducted a systematic literature search of MEDLINE from 1966, EMBASE from 1990, Science Citation Index from 1994, and the Cochrane Systematic Review Database up to April 2006, to identify studies that examined the association between habitual coffee consumption and CHD, with an analytical design—either case–control (retrospective or nested) or longitudinal. We used a combined text word and medical subject headings (MeSH) search strategy with the terms ‘coffee’ and ‘caffeine’ in combination

Case–control studies

Characteristics of the case–control studies included in the meta-analysis are described in Table 1. The vast majority of these studies had myocardial infarction as the primary outcome. Fig. 1 shows the results of case–control studies for different levels of coffee consumption, compared with the lowest level of coffee consumption. First, we compared the highest category of coffee consumption with the reference category. The summary OR from a random-effect model showed that individuals who

Discussion

The present meta-analysis, performed in 13 case–control and 10 cohort studies, with an overall incorporated population of more than 430,000 subjects and 18,000 CHD cases, shows no clear indication that coffee consumption determines an increased risk of CHD. An association among the highest categories (mainly >2 cups per day) of coffee drinking and CHD within case–control studies has been reported. However, this result was not confirmed among cohort prospective studies with a follow-up period

Acknowledgments

This research was submitted to a Call for Research on Coffee and Cardiovascular Diseases and selected for a grant by SINU, (Italian Society of Human Nutrition).

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