The impact of coffee subtypes on incident cardiovascular disease, arrhythmias, and mortality: long-term outcomes from the UK Biobank
Sept 27 2022
Conclusion
Decaffeinated, ground, and instant coffee, particularly at 2–3 cups/day, were associated with significant reductions in incident CVD and mortality. Ground and instant but not decaffeinated coffee was associated with reduced arrhythmia.
Overall coffee intake and incident cardiovascular disease
Cardiovascular disease was diagnosed in 43 173 (9.6%) participants during follow-up. A total of 34 677 (7.7%) participants were diagnosed with incident CHD, 12 966 (2.8%) with incident CCF, and 6767 (1.5%) with incident stroke. Habitual coffee intake of up to 5 cups/day was associated with significant reductions in the risk of incident CVD, when compared with non-drinkers. Significant reductions in the risk of incident CHD were associated with habitual coffee intake of up to 5 cups/day, with the lowest risk for CHD observed in those who consumed 2–3 cups/day (HR 0.89, CI 0.86–0.91, P < 0.0001). Coffee consumption at all levels was associated with significant reduction in the risk of CCF and ischaemic stroke (Figure 2). The lowest risks were observed in those who consumed 2–3 cups/day, with HR 0.83 for CCF (CI 0.79–0.87, P < 0.0001), and HR 0.84 for ischaemic stroke (CI 0.78–0.90, P < 0.0001; see Supplementary material online, Table S2).
Overall coffee intake and all-cause/cardiovascular mortality
A total of 27 809 (6.2%) participants died during long-term follow-up, including 4402 (1.0%) from CV causes. A significant reduction in all-cause mortality was associated with coffee consumption up to 5 cups/day, with the greatest effect seen with 2–3 cups/day (HR 0.86, CI 0.83–0.89, P < 0.0001). A significant reduction in CV mortality was observed in coffee drinkers of 1–5 cups/day (lowest risk 1 cup/day; HR 0.82, CI 0.74–0.90, P < 0.0001; see Supplementary material online, Figure S1). Coffee intake was not associated with a risk of sudden cardiac death (see Supplementary material online, Figure S2).
Ground coffee
Of the 82 575 ground coffee drinkers, an arrhythmia was diagnosed in 5872 (7.0%) which was predominantly AF/flutter (3269, 3.9%); CVD in 8670 (10.5%), CHD in 7154 (8.6%), CCF in 1976 (2.3%), and stroke in 1114 (1.3%). Total mortality was 5.5% (4511) at a median follow-up of 12.5 years (IQR 11.7–13.2). Ground coffee intake between 1 and 5 cups/day was associated with a significant reduction in the incidence of any arrhythmia, and specifically AF/flutter (Figure 3A, Supplementary material online, Table S4). A reduction in SVT and VT/VF risk was seen with 2–5 cups/day (Figure 3B). Ground coffee consumption at up to 5 cups/day was associated with a significant reduction in the risk of CVD, CHD, and CCF (Figure 4). Ground coffee consumption at all levels significantly reduced the risk of all-cause and CV mortality (Figure 5). All-cause mortality was lowest at 2–3 cups/day (HR 0.73, CI 0.69–0.78, P < 0.0001), whereas CV mortality was lowest at 4–5 cups/day (HR 0.65, CI 0.51–0.83, P < 0.0001; see Supplementary material online, Table S5).
Instant coffee
Of the 198 062 instant coffee drinkers, an arrhythmia was diagnosed in 16 696 (8.4%) which was predominantly AF/flutter (9273, 4.7%), CVD in 29 751 (15.0%), CHD in 25 051 (12.6%), CCF in 7029 (3.5%), and stroke in 3707 (1.8%). Total mortality was 7.7% (15 365) at a median follow-up of 12.5 years (IQR 11.7–13.2). In general, a U-shaped relationship was observed between instant coffee intake and the various CVD endpoints. In particular, 2–3 cups of instant coffee/day was associated with the lowest risk for any arrhythmia (HR 0.88, CI 0.85–0.92, P < 0.001), CVD (HR 0.91, CI 0.88–0.94, P < 0.0001), CHD (HR 0.91, CI 0.88–0.94, P < 0.0001), stroke (HR 0.83, CI 0.76–0.90, P < 0.0001), and all-cause mortality (HR 0.89, CI 0.86–0.93, P < 0.0001; Figures 4 and 5). Amongst the arrhythmia subtypes incident risks were lowest at 4–5 cups/day for AF/flutter (HR 0.85, CI 0.79–0.91, P < 0.0001; Figure 3A), and SVT (HR 0.75, CI 0.63–0.88, P = 0.0005; Figure 3B, Supplementary material online, Table S4).
Decaffeinated coffee
Of the 68 416 decaffeinated coffee drinkers, an arrhythmia was diagnosed in 6737 (9.8%) with (AF/flutter in 3889), CVD in 9904 (14.5%), CCF in 2263 (3.3%), and ischaemic stroke in 1224 (1.7%). Total mortality was 10.9% (7434) at a median follow-up of 12.5 years (IQR 11.7–13.2). The risk of CVD, CHD, and CCF were reduced particularly with an intake of 2–3 cups/day, with hazard ratios of 0.94 (CI 0.90–0.99, P = 0.0093), 0.94 (CI 0.89–0.99, P = 0.0127), and 0.86 (CI 0.79–0.94, P = 0.0004), respectively (Graphical Abstract). A U-shaped relationship was demonstrated between decaffeinated coffee intake and all-cause mortality, with the lowest risk seen with 2–3 cups/day (HR 0.86, CI 0.80–0.91, P < 0.0001). Cardiovascular mortality was also reduced at a coffee intake between 1 and 3 cups/day (lowest risk 1 cup/day: H