Caffeine: a better drug to prevent heart disease than statins
I’m on an anti-statin roll today.
I just got my February issue of the American Journal of Clinical Nutrition, which contains a wonderful article on the heart 
disease prevention properties of caffeine. In a prospective study of 6596 subjects, aged 32-86, lasting 8.8 years, researchers found that caffeine (delivered via coffee, primarily) prevented the development of heart disease and heart-disease mortality in numbers that would make the CEOs of any statin-manufacturing pharmaceutical companies wet themselves.
Based on the data, adults over the age of 65 who consumed the equivalent of greater than 4 cups of coffee per day had a whopping halving of the risk (actually, a little greater than half) for death from heart disease, a statistic that no statin research can even come close to. The great thing about the caffeine data is that there is a dose-response curve. A dose-response curve is one that shows an increasing effect with increasing dose of the drug in question. In the case of caffeine, the smaller the dose, the smaller the benefit: from a half cup to two cups per day, the risk drops about 23%; from 2 cups to 4 cups per day, the risk drops by 32%; more than 4 cups per day, a 53% decrease in risk.
What about subjects under the age of 65? The data didn’t show any decreased risk, but I suspect the reason is that not enough of those people developed heart disease or died from it during the 8.8 years of the study to make the findings statistically significant.
Also, all the subjects were free of heart disease at the start of the study, so the study doesn’t address the possible protective effects of caffeine on people who already have developed heart disease.
If you remember from the statin data, there has been no data showing that statins confer any protection for people who don’t already have heart disease, yet the vast majority of people taking statins fall into this category. For those people, it would seem that the better strategy would be to ditch the statins with all their attendant side effects and grab a cup (or four) of Joe every day. Fewer side effects, much more enjoyment, and prevent heart disease to boot (not to mention diabetes, Alzheimer’s and Parkinson’s).
Based on the results of this study, Starbucks prevents more heart disease than all the drug companies put together.
Addendum: In my rush to get this post into print I overlooked a couple of things that I really need to address. First, we can’t really compare these coffee studies head to head against statins because the statin studies were double-blind, placebo-controlled studies; this coffee study was a prospective epidemioligical study. In this coffee study researchers looked at the coffee consumption habits of the subjects, interviewed them over the years to confirm their reported consumption, then waited to see how many developed problems. To be able to compare this study legitimately against the statin studies, the researchers would have randomized their subjects (none of whom were coffee drinkers) into two groups, then provided coffee in various ‘doses’ to one group and a placebo that looked and tasted like coffee to the other. Neither the subjects nor the researchers would know which group had the coffee and which had the ersatz coffee. Then, after a period of time, the codes as to who had what would be opened and the data tabulated. If it turned out then that the subjects who drank the real coffee had much less risk of developing heart disease than the ones who didn’t, we could say that coffee decreases the risk more than statins.
Having said all that, I can still say that there are many, many studies out there indicating that coffee has a protective effect against heart disease, Alzheimer’s, Parkinson’s and diabetes. So I highly recommend it. In fact, I’ll go on record as saying that if we could have a double-blind, placebo-controlled study of coffee I predict that coffee would be much more protective against heart disease than the statins. But I can’t really say it from this study.
What about those of us who don’t like the flavor of coffee? Is it just the caffeine, or something else in the coffee? Could tea be effective also?
Hi Martha–
The study showed that caffeine from tea is just as effective. You’ve just got to drink a fair amount more tea to get the same amount of caffeine as coffee.
Cheers–
MRE
So I take it that I can use tea instead of coffee? I recently gave up my quad grande americano, thinking that I was improving my health and substituting lots of green tea, about a quart throughout the day. There’s also an issue with rosacea that could be affected by taking that much coffee in the morning. What do you think, Dr Mike?
Hi LC–
You can drink tea instead of coffee, at least according to the results of this study. Other studies indicate that coffee is a better choice. I’m unaware of a connection between rosacea and coffee. That doesn’t mean there isn’t an association, just that I’m unaware of one.
MD has a touch of rosacea and she (along with me) drinks a ton of coffee and it doesn’t seem to bother her. There you have it. My anecdotal study with an N of one subject.
Cheers–
MRE
Dear Dr. Eades,
Do you think that caffeine affects one’s concentration and performance during a round of golf?
Thank you for your wonderful blog. I read it every day on my laptop in the bathroom.
Sincerely,
db
Hi db
I don’t know about the concentration during golf. I played a few days ago after drinking a couple of cups of coffee against this guy whose game turned to crap a few months back. He drank no coffee prior to the round. On about the 12th hole his game came to life and he beat me like a rented mule. I drank coffee; he drank none. I don’t know what conclusion I can draw from that. Maybe you can do a PubMed search on the subject during your next trip to the john. Keep us all posted on the results.
Cheers–
MRE
(db is the very golf buddy who pounded me so badly)
Is it the coffee or the caffeine? If it’s the coffee I have 2 cups (1 large mug) in the morning and that’s usually it. Occasionally I hit Starbucks, but not too often. If it’s the caffeine then I get plenty every day from diet soda, green tea, and an occasional diet energy drink (today I needed the triple strength diet Rock Start just to get through my workout!).
Hi Victoria–
In the case of this study, it is caffeine. It’s just that most of the caffeine consumed by the subjects was coffee.
Cheers–
MRE
Dr. Mike,
How about the effects of coffee/caffeine on blood pressure? I’ve read about a study that found no effect on blood pressure in women, but I’ve seen no info for men.
Barney
Hi Barney–
I’ve seen studies showing both an increase and no change in blood pressure in men and women. In this study, the subjects who drank the most coffee took were primarily male and fewer took blood pressure meds than those with lesser caffeine consumption.
Cheers–
MRE
Oh my goodness, you’re drinking Starbucks?! Ewwwwe! I gotta tell ya, Starbucks is the worst coffee on our lovely planet. My beef is that it is way over roasted… burnt. Definitely 2nd class beans. Even worse than 2nd class chocolate (and we all know how awful that can be!).
If you or your lovely bride ever get the opportunity to visit our frigid Chicagoland, PLEASE drop by for some well-prepared, super-excellent-primo 100% Columbian fresh ground (not over roasted or burnt), drip-brewed (or percolated), 3.25 oz at exactly 206* F, genuine COFFEE!
Really. I am NOT a coffee snob.
Hi Karen J–
I agree with you about Starbucks, but my bride loves it. We’ve been drinking Starbucks since back when you could only get it via direct mail (unless you happened to live in Seattle). We happened to be in Chicago when the first Starbucks outside of Seattle opened there. We loaded up with stuff before heading back to Little Rock.
I’ll take you up on the offer next time we’re in town. What kind of coffee do you use?
Since we started drinking Americanos I don’t particularly like drip coffee. I’ll drink it if I have to, but I much, much prefer a Cafe Americano.
Best–
MRE
Dr. Eades,
Do you feel that caffeinated coffee would be a better choice than Diet Coke? I am a bit of a Diet Coke addict (finding it quite hard to ‘kick’ the habit), and finding that Diet Coke causes voracious late-night carb cravings in me (that virtually disappear if I haven’t had Diet Coke that day.)
Have you seen/heard of this effect, and if so, do you know if coffee also produces it?
Thanks for any reply.
Hi Tom–
There is a little less than one third the caffeine of a cup of coffee in a Diet Coke. You might want to try the switch to see what happens. I suspect that your problems with Diet Coke may stem more from the aspartame than from the caffeine.
Let me know how you do if you try the coffee.
Best–
MRE
In my book, nothing gives you more bang for your buck caffeine-wise than coffee brewed in a French-press pot.
Coming from a German background like I do, I grew up around a bunch of die-hard kaffee drinkers so it’s like mother’s milk to me. Maybe that’s the reason they all live so long (late 80′s – mid 90′s on average.)
Hi Esther–
MD and I used to drink our coffee brewed in a French-press pot all the time. That was before we experienced the virtues of Cafe Americano. If we are without our espresso maker, we always use a French press. We have a little one that we travel with.
Cheers–
MRE
Thanks, Dr Mike. My sister’s mother-in-law had a bad case of rosacea and was told to avoid both caffeine and alcohol. Also, she was prescribed what I think was the only rosacea medication at that time in the 80′s, and I can’t remember its name! Maybe Dr Mary Dan knows of it and others?
Hi LC–
The drug you’re probably thinking of is metronidizole, which is a topical treatment for rosacea that has been around for a while. I’ve found that oral antibiotics such as erithromycin, minocin, and doxycycline work pretty well. I’m sure the dermatologist have probably got a bunch of new remedies since rosacea is such a common condition.
Best–
MRE
Dr. Eades,
We like Eight O’Clock 100% Columbian most of the time. If you like a darker roast, Caribou Columbian is very good. They are both excellent coffees- earthy, floral, winey, and mellow.
However, they don’t have the astringency that Starbucks has, which might not appeal to you.
Hi Karen J–
I don’t particularly like the astringency of Starbucks, but MD does. I’ll give the two you recommend a try if I can get them ground for espresso.
Thanks–
MRE
re Metronidazole.
In the UK patients, patients are warned to avoid alcohol whilst taking this drug, or risk the mother of all headaches. This is routine advice, but I can’t say I’ve ever come across anyone who paid the price!
Hi Neil–
Metronidizoe – trade name Flagyl – does indeed have Antibuse-like effects. Patients are always warned about drinking while taking it. I have given a zillion prescriptions of it for a number of parasitic infections, but I don’t recall anyone ever telling me about a problem with drinking. Either none of my patients drank alcohol while taking it or none of them reported any side effects to me if they did.
Cheers–
MRE
Just to put my 2 cents in, I use coffee as a base, adding alcohol usually in the form of whiskey or rum and occasionally unsweetened cocoa. I do take a Splenda flavored syrup and cream which may slightly reduce its poly (liquid) protection against heart disease and diabetes. My bride agrees with you on Starbucks, to the degree that entering the store makes her ill.
While I have progressed to occasionally grinding my own beans (as a sidenote, I’d be curious if anyone has studied that aspect, ground vs. freshly ground) I’m ignorant of what cafe americano is. Finally, the note about pregnant women giving up (coffee), if it did cause birth defects in any number, it would make thalidomide look like a picnic in the park. And since the most dangerous time would be in the first trimester when many women wouldn’t even know they’re pregnant, it’s tantamount to advising all women not using contraception to give up coffee. At the end of the day, it’s an individual decision, balancing a very small risk against a somewhat larger health benefit.
Thanks as always for the time and space to comment.
Hi Mark–
Interesting comment and on the mark about the thalidomide.
Cafe Americano is a couple of shots of espresso and enough extremely hot water to fill up the rest of a normal coffee cup. In Italy there are no drip coffee makers–it’s all espresso. Since Americans enjoy drip coffee, the Italians figured out how to approximate the taste by using the mixture of espresso and water. MD and I love it because it is tastier (we think) than regular drip coffee and is always hot and fresh.
Cheers–
MRE
The espresso’s even tastier if you don’t top it up with extra water.
Hi Janet–
That’s a matter of preference. I prefer it with the water. If it were just the espresso it wouldn’t be an Americano.
Cheers–
MRE
I’ve been advised to avoid caffeine by my cardio (afib), and have never drunk coffee anyway. Would all of the caffeine in a chocolate- flavored whey powder (no sugar) be used in the “stimulant process” after consumption of two scoops, or would some be excreted in the urine? Does caffeine compete with beta blocker-type drugs at the beta-adrenergic receptors?
Hi athelstan–
I don’t know how much caffeine is in two scoops of chocolate whey powder, so I can’t really say whether or not there is enough to cause problems. I doubt that there is a whole lot.
Caffeine is a central nervous system stimulant that doesn’t work through the beta receptors. It is metabolized in the liver, not the kidneys.
Best–
MRE
For the person with the Diet Coke problem – try switching to Pepsi One if you want the caffeine but what to avoid the aspertame. I wish Coke still had their Diet Coke with Splenda, but alas, now only Pepsi has caffeine AND Splenda. A couple other soda marketers have Splenda sweetened soda, but it’s also caffeine free.
Hi Victoria–
Thanks for the rundown of the soda market. I don’t drink them, so I don’t have a clue as to what contains what.
Best–
MRE
I have symptoms of hypoglycemia (brain fog, slight vertigo) after drinking coffee, and also indigestion if I have more than a couple cups in one day. Switching to decaf clears up both.
About a week ago I switched to green tea (giving the ECGC another chance vs. my stubborn last 20 pounds), and so far have had no ill effects, just the normal somewhat hyper alertness that I expect will settle down as I adapt to the caffiene.
Still, I like coffee occasionally. I put coconut milk in it (and in tea) – lovely stuff. I also favor the French press. For some reason even freshly made drip coffee tastes overcooked, harsh and stale in comparison.
Hi Lark–
I totally agree with you about French pressed coffee: it’s by far the best of the brewed coffees. But, for my taste, it can’t hold a candle to an Americano, which has a lot less caffeine. French pressed coffee caffeine levels are probably the highest of all the brewed coffees.
Cheers–
MRE
What about caffeine supplementation (as it has also shown benefits in endurance and weightloss)?
Any thoughts about a:
Overstimulating the adrenals (exacerbating adrenal fatigue).
Causing tolerance, given that caffeine is a stimulant.
For those 2 reasons, I’ve always favored decaf, although I respond well to caffeine. That LDL study is making me reconsider.
Fantastic articles (among many, I’m just getting started reading them!).
Much thanks,
Paul
Hi Paul–
If caffeine causes adrenal fatigue, I’ve probably got the most fatigued adrenals in America. I have always thought the idea of adrenal fatigue was a little overblown. I’m sure I’ll hear from a lot of people claiming the opposite, but until I see credible information to the contrary, that’s my take on it.
I’m sure that with increased consumption one becomes more tolerant of caffeine. But, at least in my case, not a whole lot more tolerant.
Give the caffeinated version a go. See how you feel with it and moderate as necessary.
I firmly believe that coffee is a pretty healthy drink, but if I hated the taste of the stuff, I certainly wouldn’t force it down. I think a lot of people love coffee, but are afraid to drink it. It’s to those peolple I say, bottoms up.
Cheers–
MRE
OK, I love this, but isn’t it still the case that caffeine interferes with sleepiness? (I mean, the sleepiness you want to feel when it’s bed time, not the sleepiness you feel when you need to be alert and working.)
Once I hit 40 I found I couldn’t really cope with much caffeine after noon and still sleep at night. So I have my caffeinated coffee at breakfast, and then switch to decaf for any other I drink later in the day.
Though at the same time I’ve always ingested a lot of Diet Peach Snapple iced tea (until a couple weeks ago when I read something that convinced me to give up aspartame in favor of drinks containing Splenda only), and that probably has plenty o’caffeine in it, though there’s no accounting of such in the labeling.
Hi herself_nyc–
There is no question that caffeine interferes with sleep. I drink nothing but decaf after about 6 PM. And it gets worse with age because liver function falls off with age. The liver detoxifies the caffeine, so if your liver isn’t working as well as it used to, you won’t be able to metabolize the caffeine as quickly, and it will take you longer to be free of its effects. That’s why young people can drink coffee at night and have no trouble sleeping, but as they age the time at which they start switching over to decaf gets earlier and earlier. I hate the taste of decaf coffee, which is why I like Cafe Americano. Even the decaf tastes good.
Cheers–
MRE
I’m wondering if there is any information/studies on the effects of chickory?? The wife and I love our Community Chickory Blend coffee (New Orleans style)
Hi Steve–
I don’t know of any studies on chicory (which MD and I love as well), but I can’t imagine that it would be harmful. If you find anything, let me know.
Best–
MRE