It's National Coffee Day-Let's Celebrate The Health Benefits Of Java!

The skeptical cardiologist admits to being a coffee snob and addict. For the last 10 years, I’ve been using the Chemex system to brew my morning cup of Java.

Once I consistently partook of Chemex pour-over coffee made from freshly ground, recently (lightly) roasted, quality coffee beans it was hard for me to enjoy any other kind. I find Starbucks coffee particularly loathsome.

Although numerous studies have established that coffee consumption is safe (assuming you are not adding  titanium dioxide to your cup), the belief that it is bad for you persists in the majority of patients that I see.

Since today is National Coffee Day let me take this opportunity to reassure my patients and readers who consume the good brew that they are not harming their hearts.
While it is possible to adulterate coffee into an unhealthy concoction (see my post on “How Starbucks Is Making Heart Healthy Coffee Into a Stealth Dessert”) overall coffee is heart-healthy.
In fact, a recent study (Coffee Consumption and Coronary Artery Calcium Score: Cross‐Sectional Results of ELSA‐Brasil (Brazilian Longitudinal Study of Adult Health)) showed that coffee consumption is associated with less subclinical atherosclerosis as measured by coronary artery calcification (CAC).
The intro to this paper summarizes information known about coffee and cardiovascular disease (CVD). Although early observational studies suggested coffee could increase risks:

More recent meta‐analysis of prospective studies showed that moderate coffee consumption was associated with decreased CVD risk, all‐cause mortality, and mortality attributed to CVD and neurologic disease in the overall population. High coffee consumption (>5 cups/d) was neither related to CVD risk nor to risk of mortality. To corroborate this evidence, the 2015–2020 Dietary Guidelines for Americans show that consumption of 3 to 5 cups/d of coffee is associated with reduced risk of type 2 diabetes mellitus and CVD in adults. Consequently, moderate coffee consumption can be incorporated into a healthy dietary pattern, along with other healthful behaviors. Although coffee consumption has been studied in relation to various risk factors of CVD, only 4 studies have investigated the association between coffee intake and subclinical atherosclerosis, and the data available were limited and inconsistent.

Coffee is rich in phenolic compounds which have demonstrated anti-inflammatory, antioxidant, and antithrombotic properties which could lower cardiovascular risks. However, unfiltered coffee is rich in cholesterol‐raising compounds (diterpenes, kahweol, and cafestol) that can increase total cholesterol, low‐density lipoprotein cholesterol, and triglycerides which could worsen cardiovascular risk.

Consumption of filtered coffee however does not effect lipid levels adversely- presumably, those nasty diterpenes are retained by my Chemex filter.
The Brazilian Longitudinal study looked at 4426 residents of Sao Paulo, Brazil who underwent a CAC measurement.  Information on coffee consumption was obtained from a food frequency questionnaire.

Those who reported high coffee consumption (>3 cups per day) had one-third the chance of a CAC>100 than nondrinkers. More coffee=less plaque build up in the coronary arteries. Less atherosclerotic plaque should = fewer heart attacks and strokes.

Scientific Consensus On The Healthiness of Coffee Consumption

In contrast to what the public believes, the scientific evidence very consistently suggests that drinking coffee is associated with living longer and having less heart attacks and strokes. Multiple publications in major cardiology journals in the last few  years have confirmed this.
You can read the details here and here. The bottom line is that higher levels of coffee consumption (>1 cup per day in the US and >2 cups per day in Europe) are NOT associated with:

• Hypertension (if you are a habitual consumer)
• Higher total or bad cholesterol  (unless you consume unfiltered coffee like Turkish, Greek or French Press types, which allow a fair amount of the cholesterol-raising diterpenesinto the brew)
• Increase in dangerous (atrial fibrillation/ventricular tachycardia) or benign (premature ventricular or supra-ventricular contractions) irregularities in heart rhythm

Higher levels of coffee consumption compared to no or lower levels IS associated with:

• lower risk of Type 2 Diabetes
• lower risk of dying, more specifically lower mortality from cardiovascular disease
• Lower risk of stroke

So, if you like coffee and it makes you feel good, drink it without guilt, there is nothing to suggest it is hurting your cardiovascular health. It’s real food. These tend to be good for you.

Nonpoikilothermically Yours,
-ACP
N.B. The Chemex Coffeemaker was invented in 1941 by Dr. Peter Schlumbohm PhD. Made simply from non-porous, borosilicate glass and fastened with a wood collar and tie, it brews coffee without imparting any flavors of its own. On permanent display at MOMA NY and other fine museums, it is truly a work of art.
Despite Kaldi’s gastronomic abomination, I’m still predominantly using their coffee beans.
The Brazilian coffee study has numerous flaws like all observational dietary studies.
The caffeine in coffee can bring on palpitations. If you feel palpitations or other symptoms after consuming coffee you should lower the caffeine content or amount until you no longer experience troubling symptoms. Be guided by how you feel.

 (This article was updated 3/26/2023. I still choose Kaldi’s coffee bean when I’m in St. Louis. My brand of choice in San Diego is Bird Rock Coffee Roasters.)