Safety of coffee consumption after myocardial infarction: A systematic review and meta-analysis

Highlights

• We aimed to assess the association between coffee consumption and mortality and cardiovascular risk after myocardial infarction.

• Higher coffee consumption was associated with lower risk of all-cause mortality and cardiovascular mortality.

• Long-term coffee consumption is safe after myocardial infarction.

Abstract

Background and aims

This systematic review aims to evaluate the impact of coffee consumption in patients with previous myocardial infarction (MI), in relation to all-cause and cardiovascular mortality, as well as other major cardiovascular events (MACE) such as stroke, heart failure, recurrent MI and sudden death.

Methods and results

MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, SciELO Citation Database, Current Contents Connect®, KCI Korean Journal Database, African Index Medicus, and LILACS were searched for longitudinal studies evaluating the impact of coffee consumption in patients with previous myocardial infarction. We performed a random-effects meta-analysis to estimate the pooled hazard ratios (HR) with 95% confidence intervals (CI). The statistical heterogeneity was measured by I². A dose–response analysis was also conducted.

Six prospective cohort studies were included in the primary meta-analysis. Consumption of coffee was associated with lower risk of cardiovascular mortality (HR = 0.70; 95% CI 0.54–0.91, I² = 0%; 2 studies) and was not associated with an increased risk of all-cause mortality (HR = 0.85; 95% CI 0.63–1.13; I² = 50%; 3 studies), recurrent MI (HR = 0.99; 95% CI 0.80–1.22; I² = 0%; 3 studies), stroke (HR = 0.97; 95% CI 0.63–1.49; I² = 39%; 2 studies) and MACE (HR = 0.96; 95% CI 0.86–1.07; I² = 0%; 2 studies). A significant non-linear inverse dose–response association was found for coffee consumption and all-cause mortality.

Conclusions

Consumption of coffee was not associated with an increased risk of all-cause mortality and cardiovascular events in patients with previous myocardial infarction.

Introduction

Ischemic heart disease is the leading cause of death in adults worldwide, according to the World Health Organization (WHO). Plaque rupture with thrombus formation in a coronary vessel results in an acute reduction of blood supply to myocardium, leading to myocardial infarction (MI) with irreversible damage [1].

Patients with previous myocardial infarction face a significant risk of further cardiovascular events, including recurrent MI, stroke, heart failure, arrhythmias and death [2]. Therefore, information regarding prognosis and management after myocardial infarction is of the utmost importance for clinical practice. Pharmacological measures, such as antiplatelet treatment and statins have an important prognostic role in the secondary prevention on patients with previous MI [3]. Concomitant non-pharmacological approaches, such as adopting healthy lifestyles (physical activity and diet) are desirable. Much is known and debated about how diet modulates cardiovascular risk factors (lipids and blood pressure) [4,5], but presently there are no recommendations about coffee consumption in this population. Despite the link of coffee consumption with myocardial infarction, there are studies, mostly based in disease-free populations, showing that coffee does not increase the MI risk [6,7].

Coffee is one of the most consumed beverages worldwide, and the understanding of the potential physiological effects of its consumption, either beneficial or harmful, may have meaningful implications for public health and patient care. Its consumption and association with cardiovascular disease has been studied extensively [[6], [7], [8]]. However, it is of critical importance to assess its clinical impact in the whole spectrum of potential consumers. Previous studies have focused on the effect of coffee in the development of acute myocardial infarction, but few have studied the impact of coffee consumption on prognosis in patients with previous MI.

Hereupon, we aimed to systematically study the risk of mortality and new cardiovascular events associated with coffee in patients with history of myocardial infarction.