Is coffee good for your heart?

Every day, I get up and make myself a cup of coffee. I used to drink instant, moved on to pods and then ultimately graduated to grinding my own. I drink about 2-3 cups during the day, sometimes more if I’ve been on call the night before.

As a cardiologist, I’m asked nearly every week by a patient, friend or family member if they can drink coffee:

“I’ve had a heart attack. Can I ever have a cup of coffee again?”

“I know my blood pressure is up a little bit today, but I had a cup of coffee this morning.”

“I’ve been having palpitations. Should I switch to decaf?”

The reality is that there’s very little data to suggest that coffee, even in moderate quantities, is bad for us. In fact, multiple recent studies have suggested just the opposite — good news for us daily coffee drinkers. The reason for these beneficial findings is not well established. It’s been speculated that antioxidants in coffee are the cause of this effect, as both caffeinated as well as decaf coffee have been linked to potential health benefits.

Besides cardiac disease, there are studies suggesting that coffee intake is associated with reductions in cancer, stroke, diabetes, and inflammatory disease.

Large studies have suggested that in persons who regularly drink coffee, there’s a reduction in overall rates of mortality. This was borne out in other studies, in multiple different countries, involving many ethnicities. Interestingly, drinking more coffee daily seems associated with increased benefits, and the groups of people who drink more than 5 cups a day did the best. Besides cardiac disease, there are studies suggesting that coffee intake is associated with reductions in cancer, stroke, diabetes, and inflammatory disease.

But you’re here because you’re concerned about how coffee might affect your heart health. Let’s break it down.

How coffee influences your risk of heart attack

There are not a lot of studies looking at whether drinking coffee after a heart attack is good or bad. In one study, patients who were coffee drinkers at the time of their heart attack fared better than patients who had heart attacks who did not drink coffee. Usually, my patients who have had heart attacks are battling far worse types of behaviors, and coffee drinking is not something that I discourage.

Studies show that coffee may even reduce cardiovascular events in older patients by slowing down valvular disease. Long term, higher consumption of coffee has been associated with fewer cardiac events such as heart attack.

It’s true that studies from many years ago seemed to have implicated coffee drinking with increased heart attacks, but when they looked at those patients who ended up with heart disease, it was associated with tobacco use, not the coffee they were drinking.

Potential downsides of drinking coffee

Some people find that coffee doesn’t agree with them, and there are people who have negative side effects such as headaches, dizziness, GI issues and the inability to sleep. We used to ask persons who had palpitations (extra heart beats) to cut down on coffee, but more recent data suggests that the coffee isn’t causing these problems, and there’s no reason they have to stop drinking it.

It’s notable that these theoretical benefits — or at least non-detriments — are not carried over to caffeine-laden energy drinks. There are many reports of harmful effects when these types of drinks are used or abused, in particular in young or vulnerable populations, i.e. children.

Here’s my final take on coffee. Drinking coffee is not a substitute for taking medications (when prescribed), maintaining a healthy weight, abstaining from tobacco or moderating alcohol intake. The associations between coffee and improved health in these studies may be simply that — associations, not direct causes. At the very least, very few negative consequences of drinking coffee have been reported.

So, when my patients ask me if they can still have their coffee (without a side of guilt), I tell them to enjoy their cup of joe.

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