Does Coffee Pose a Risk for Individuals with Hypertension, Diabetes, and Heart Disease?

Coffee and caffeinated beverages rank among the most widely consumed drinks worldwide. Approximately seven out of every eight individuals in the United States regularly consume caffeine, with an average daily intake of 135 mg.

Coffee boasts the highest concentration of caffeine among commonly consumed beverages, making it a subject of scientific investigation regarding its impact on various diseases.

A recent study, published in Nutrition, Metabolism and Cardiovascular Diseases, delves into the relationship between coffee consumption and abdominal aortic calcification (AAC) in adults with and without hypertension, diabetes, and cardiovascular disease (CVD).

Moderate coffee consumption has been linked to a reduced risk of several diseases, such as metabolic syndrome, Parkinson’s Disease (PD), type 2 diabetes, and certain types of cancer. It is worth noting that even a single cup of coffee per day has been associated with a lower mortality risk.

However, it should be noted that high coffee consumption may elevate the risk of CVD in individuals with severe hypertension due to the acute increase in blood pressure that follows coffee consumption. Additionally, coffee has been found to induce insulin insensitivity, and excessive intake may raise the risk of mortality from any cause, particularly among individuals with CVD.

These findings suggest that the benefits of coffee consumption vary depending on the presence of pre-existing hypertension, hyperglycemia, and CVD.

Lower coffee consumption has been associated with the calcification of coronary arteries. In this particular study, researchers utilized abdominal arterial calcification (AAC) as an early marker of atherosclerosis, which occurs prior to the actual development of clinical disease.

The objective was to examine whether coffee had any effect on the AAC profile in two groups of adults. The study made use of data from the National Health and Nutrition Examination Survey (NHANES) conducted during the period of 2013-2014, involving a participant pool of over 2,500 individuals. The severity of AAC was assessed through dual-energy X-ray absorptiometry (DXA).

The participants were divided into three categories based on their total coffee intake: no consumption, low consumption, and high consumption (with a cut-off of 390 g/day or more). Similar categorizations were also made for caffeinated coffee drinkers. Due to the limited number of decaffeinated coffee drinkers, only two groups were formed in relation to decaf coffee consumption: those who consumed decaf coffee and those who did not.

AAC severity was evaluated using the Kauppila system, which involves visually assessing the degree of calcification in the aortic wall across eight segments obtained from lateral spine DXA imaging (four posterior and four anterior). The individual scores from each segment were then aggregated, with a score exceeding 6 indicating severe AAC.

During the analysis of risk factors, various factors such as smoking, dietary patterns, kidney disease, plasma lipids, and other valuable metabolites were taken into consideration to mitigate any potential confounding effects.

What were the findings of the study?

The study revealed that the majority of coffee drinkers were older individuals, White, and current smokers. However, there were fewer coffee drinkers among those who had diabetes. Coffee drinkers also exhibited higher average levels of vitamin D and incomes, but they had lower kidney function and poorer diet quality.

Overall, no significant associations were found between coffee consumption and AAC scores. However, among individuals with hypertension, diabetes, or cardiovascular disease (CVD), those who consumed a high amount of coffee (390 g/d or more) showed higher AAC scores.

In the hypertensive group, individuals with high coffee consumption had an AAC score that was 0.72 units higher compared to those who did not consume coffee. This difference was not observed in non-hypertensive individuals.

Among individuals with diabetes, the difference in AAC scores was 1.2 units for high coffee consumers compared to non-consumers. Similarly, individuals with CVD who consumed high amounts of coffee had AAC scores that were two units higher than those who did not have coffee. These associations were not seen in adults without these underlying conditions.

Similar results were obtained when comparing decaf and caffeinated coffee drinkers. Those who consumed decaffeinated coffee did not show an increased risk of higher AAC scores. However, caffeinated coffee drinkers exhibited an elevated risk, especially when they had hypertension, diabetes, or CVD.

The study indicated that the risk of severe AAC was increased by 50% among individuals with high coffee consumption. When hypertension was present in addition to high coffee consumption, the risk escalated to 70%. While excessive coffee drinking in conjunction with diabetes or CVD increased the odds of severe AAC, the difference compared to those without these conditions was not statistically significant.

What are the implications of the study?

This study suggests that individuals with hypertension, diabetes, and cardiovascular disease (CVD) should “should focus on coffee consumption, especially caffeinated coffee, to reduce the burden of AAC.”

Coffee intake can lead to acute increases in blood pressure, reduced endothelial function, impaired glucose absorption responses, heightened sympathetic arousal, and disrupted sleep patterns. Although caffeine’s metabolic benefits usually counteract these effects, they may have harmful consequences when combined with AAC risk factors in specific subgroups. Several studies have indicated an increased risk of cardiovascular death among hypertensive individuals or those with CVD who consume excessive amounts of coffee.

Moreover, coffee drinking has been associated with a higher likelihood of sudden cardiac death among individuals with coronary artery disease, although the findings from various studies remain inconclusive and conflicting.

Further investigation is needed to determine whether these differences in outcomes are influenced by variations in coffee type, ethnicity, or the duration of follow-up in the studies.

It is important to note that while earlier research has demonstrated the potential benefits of coffee consumption on coronary artery calcification, these findings cannot be automatically extrapolated to other arteries, particularly the abdominal aorta.

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