Trends in Cardiovascular Medicine 32 (2022) 399–405

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Trends in Cardiovascular Medicine

journal homepage: www.elsevier.com/locate/tcm

Coffee and tea on cardiovascular disease (CVD) prevention ✩,✩✩

David Chieng a,b,c, Peter M Kistler a,b,c,d,∗
a
The Alfred Hospital, Melbourne, Australia
b
The Baker Heart Research Institute, Melbourne, Australia
c
University of Melbourne, Melbourne, Australia
d
Monash University, Melbourne, Australia

a r t i c l e i n f o a b s t r a c t

Key words: Coffee and tea are amongst the most consumed beverages worldwide, and are the main source of caffeine
Coffee in adults. In this review we present findings on the effects of habitual coffee and tea consumption on
Tea
cardiovascular disease (CVD) prevention. Mild-moderate coffee/ caffeine consumption, at 2–3 cups/day, is
Caffeine
associated with beneficial effects on metabolic syndrome, including hypertension and diabetes mellitus,
Metabolic syndrome
Coronary heart disease although may elevate lipid levels. Furthermore, coffee consumption reduces the risk of coronary heart
Arrhythmia disease, heart failure, arrhythmia, stroke, CVD and all cause mortality. Higher tea consumption, in partic-
Heart failure ular green tea, confers similar cardiovascular benefits to coffee with 3 cups/day associated with improved
Mortality survival in population based studies.
© 2021 Elsevier Inc. All rights reserved.

Introduction Methods

Coffee and tea are consumed worldwide and have been an im- We performed a comprehensive literature search in July 2021
portant aspect of societal norms and cultural traditions for cen- of PubMed, EMBASE, and Medline, focusing on human studies
turies [1,2]. Coffee’s most well-known constituent, caffeine, is a published in English. The main search terms were ‘coffee’, ‘tea’,
psychostimulant that can result in physical dependence. There has ‘caffeine’, ‘diabetes’, ‘metabolic syndrome’, ‘lipid’, ‘coronary heart
been significant interest in the health outcomes from habitual in- disease’, ‘heart failure’, ‘arrhythmias’, and ‘mortality’. The highest
take of these beverages and their potential role as modifiable risk quality studies were included in the review, including prospective
factors in cardiovascular disease (CVD). It is a common misconcep- cohorts, interventional studies and meta-analyses. Grey literature
tion that moderate coffee and tea consumption is not safe in pa- (unpublished / non commercial publications) were excluded.
tients with CVD [1]. In fact, numerous studies have reported a ben-
eficial role of moderate coffee or tea intake in CVD prevention and Coffee and tea pharmacology
management [1,2].
Research into the cardiovascular effects of coffee and tea are Coffee and tea pharmacology have been discussed previously
ongoing. Here, we aim to reappraise the current literature on the [1,2]. Coffee and tea are complex beverages that contain hundreds
impact of coffee and tea in a wide range of cardiovascular condi- of active biochemical compounds beyond the most well-known
tions. constituent of caffeine. As such, health outcomes attributed to cof-
fee and tea consumption are not necessarily confined to the main
component of caffeine itself [3].
Caffeine has a half-life of approximately 6 h, and near 100%
✩
bioavailability. One cup of coffee contains approximately 95 mg of
Declaration of Competing Interest: Dr Chieng is supported by co-funded
NHMRC / NHF postgraduate scholarship. The following industry funding sources re- caffeine, whereas black and green tea contain 55 mg and 35 mg
garding activities outside the submitted work have been declared in accordance of caffeine respectively [2]. Acute caffeine intake results in sympa-
with ICMJE guidelines. Prof. Peter M Kistler has received funding from Abbott thetic activation, which is mediated by phosphodiesterase inhibi-
Medical for consultancy and speaking engagements and fellowship support from tion, cytosolic calcium increase, and stimulation of noradrenaline/
Biosense Webster.
✩✩ adrenaline release [2]. An increase in intracellular calcium is po-
Funding: None.
∗
Corresponding author at: Heart Centre at the Alfred Hospital, 55 Commercial tentially pro-arrhythmic through atrial pacemaker cell automatic-
Road, Melbourne 3004 Australia. ity and after depolarization-induced triggered activity [4]. Indeed,
E-mail address: Peter.kistler@baker.edu.au (P.M. Kistler). animal studies have shown that high doses of caffeine (15 mg/kg

https://doi.org/10.1016/j.tcm.2021.08.004
1050-1738/© 2021 Elsevier Inc. All rights reserved.

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D. Chieng and P.M. Kistler Trends in Cardiovascular Medicine 32 (2022) 399–405

Polyphenols Caffeine
Catechins

Chlorogenic acid

• Noradrenaline/ adrenaline release

Theaflavin • Phosphodiesterase inhibion
• ↑ cAMP
• Calcium re-uptake inhibion into
sarcoplasmic reculum (SR)
• Intra-cellular Calcium ↑
• An-oxidant • A1 and A2A receptor inhibion
• An-inflammatory • Endothelial nitric oxide release
• An-oxidant
Fig. 1. Pharmacology of coffee and tea Coffee and tea contain numerous active biochemicals. Caffeine, as its main constituent, primarily results in sympathetic activation
mediated through various processes. Polyphenols such as catechins, chlorogenic acid, and theaflavins have anti-oxidant and anti-inflammatory properties.

per min) result in ventricular fibrillation (VF) [5] with media re- Coffee, tea and the metabolic syndrome
ports of sudden death following the ingestion of caffeine pow-
der. However, in modest doses caffeine intake can also be anti- Hypertension
arrhythmic through adenosine A1 and A2A receptor inhibition [2].
Other benefits of caffeine include increased endothelial nitric ox- Caffeine intake in the coffee naive can result in an acute in-
ide release leading to vasodilation, and antioxidant properties [2] crease in blood pressure (BP). However, tolerance develops in ha-
(Fig. 1). bitual drinkers with no demonstrable increase in BP despite a sim-
Coffee also contains polyphenols such as chlorogenic acid, an- ilar increase in plasma caffeine levels when compared to non-
tioxidant ferulic acid, and microelements such as magnesium. habitual drinkers [3]. This would suggest that other biochemicals
These constituents have been shown to reduce oxidative stress, beyond caffeine are likely to contribute to the BP modulating ef-
modulate metabolism, and improve gut microbiome [3,6]. Reg- fects of coffee, particularly chlorogenic acid.
ular coffee consumption resulted in an increase in the number Overall, current data would suggest that moderate levels of cof-
and metabolic activity of the probiotic Bifidobacterium spp [7].Tea fee intake decrease the risk of hypertension long term. Physiologi-
contains numerous polyphenols including catechins – epigallo- cally, coffee and caffeine consumption are linked to reduced aortic
catechin and its metabolite epigallocatechin gallate (EGCG); and stiffness, with attendant reductions in both systolic and diastolic
theaflavin/ thearubigins. Green tea contains more EGCG, whereas BP [10]. In a meta-analysis, a 9% reduction in risk of hypertension
black tea contains more theaflavins and thearubigins. Both EGCG was observed with 7 cups of coffee per day, with a 1% reduction
and theaflavins have antioxidant and anti-inflammatory properties in risk for each additional cup of coffee per day [11]. A separate
[1]. meta-analysis showed a dose-response inverse association between
More recently, genome wide association studies (GWAS) have coffee consumption and hypertension. Compared with non-coffee
identified single nucleotide polymorphisms (SNP) which decrease drinkers, the risk of hypertension in those who consumed 2, 4, 6,
caffeine metabolism, resulting in higher circulating caffeine levels. and 8 cups/day was reduced by 3%, 5%, 8% and 10% respectively
These include genes associated with CYP1A2, CYP2A6, AHR, and [12].
POR [8]. Those with slower caffeine metabolism tend to have lower Other studies have shown a non-linear relationship between
habitual caffeine intake [3]. To date, the presence of these genetic coffee consumption and hypertension risk. A meta-analysis showed
variants do not have a significant impact on the observed cardio- that a significant protective effect from coffee was only seen start-
vascular outcomes in coffee drinkers [8,9]. ing from 3 cups of coffee per day, with a relative risk (RR) of 0.97;
whereas one or two cups of coffee per day was not associated
with hypertension [13]. A further meta-analysis had suggested an
inverse ‘J-shaped’ relationship with hypertension risk initially in-
creasing up to 3 cups/day and subsequently decreasing with higher
intakes [14].

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D. Chieng and P.M. Kistler Trends in Cardiovascular Medicine 32 (2022) 399–405

Fig. 2. Effects of habitual coffee and tea consumption Habitual coffee/ tea intake at mild -moderate levels is associated with reduced metabolic syndrome, obesity, hy-
pertension, type 2 diabetes mellitus, stroke, atrial fibrillation, heart failure, coronary heart disease and mortality. Coffee intake results in raised lipid profile, whereas tea
intake reduces TC, LDL levels and potentially increases HDL levels. TC: total cholesterol; LDL: low density lipoprotein; TG: triglyceride; HDL: high density lipoprotein. (For
interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Studies on coffee consumption and hypertension risk in popu- incident obesity and metabolic syndrome [21]. A recent study in-
lation subgroups have been mixed. Women who consume higher volving middle aged patients also showed that daily coffee con-
levels of coffee had 26% lower risk of developing hypertension sumption was inversely associated with body mass index (BMI),
[15]. In elderly patients with hypertension, the risk of uncontrolled with mean effect size of −1.6 kg/m2 (OR 0.14), as well as body fat
BP progressively increased in those who consume 1, 2, and ≥3 percentage (BF%), with effect size of −3.2% (OR 0.33) [22]. Green
cups/day, when compared to non-drinkers [16]. Recent genomic coffee may have a greater effect on weight loss than roasted cof-
studies have shown interactions between genetic predisposition to fee and caffeine, likely due to a higher concentration of chlorogenic
hypertension and coffee consumption. Participants who consumed acid [6].
> 3 cups of coffee per day and a higher genetic risk score (GRS) for There is evidence that tea consumption results in weight loss
hypertension had significantly higher blood pressures compared to through the effects of caffeine and tea polyphenols, in particular
those with a lower GRS. This finding would suggest that an indi- catechin compounds like epigallocatechin [2,6]. It is hypothesized
vidualized approach to coffee intake may be needed [17]. that the tea polyphenols facilitate weight loss more through gut
A meta-analysis investigating tea consumption showed reduc- enzyme inhibition and gut microbiome interactions, rather than
tions in both systolic and diastolic blood pressures, with postulated through anti-oxidant activities [23]. Evidence for the weight loss
mechanisms including vasodilation from prostacyclin release, en- effects of tea is mostly based on green tea consumption, although
hancement of NO production and oxidative stress reduction [18]. black tea can be effective too [6,23]. Daily green tea intake resulted
Two separate meta-analyses on the effects of green tea consump- in lower BF% (effect size −2.8%, OR 0.36) in a middle aged popu-
tion also report reductions in both systolic and diastolic BP [19,20], lation [22]. Whether the synergistic effects of caffeine and cate-
with mean effects sizes ranging from −1.94 to −2.08 mmHg for chins are important to achieve weight loss, or whether green tea
systolic, and −1.71 to −1.94 mmHg for diastolic BP respectively. catechins by themselves are sufficient, remains unclear. A meta-
Fig. 2 summarizes the effects of habitual coffee/ tea consumption analysis found that either catechin or catechin-caffeine mixtures
on various cardiovascular outcomes. Habitual coffee and tea con- have beneficial effects on inducing and maintaining weight loss
sumption is not associated with hypertension and may rather be [24].
associated with a negligible reduction in blood pressure. There is
no substantial evidence to support omission of these beverages in Hyperlipidemia
the management of hypertension.
Coffee is known to contain cholesterol-increasing diterpenes,
Weight gain which include cafestol and kahweol. Earlier studies had shown
that the concentration of these diterpenes in coffee is dependent
Coffee consumption has a probable beneficial effect on weight on the brewing method. Their concentrations are high in unfil-
loss. Caffeine has a role in inhibiting gut absorption of fatty acids, tered coffee such as boiled coffee, intermediate in espresso, and
modifying gut microbiome, downregulating lipogenesis, increas- low / negligible in filtered coffee [2,3]. Indeed current evidence
ing food induced thermogenesis, and increasing the body’s basal would suggest that the coffee brewing method utilized has an
metabolic rate [6]. effect on serum lipid levels. A meta-analysis showed that boiled
Consumption of 1–4 cups of coffee per day, when compared coffee dose-dependently increased total cholesterol (TC) and low
with non-drinkers, was associated with significant reductions in density lipoprotein (LDL) levels, whereas filtered coffee resulted in

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D. Chieng and P.M. Kistler Trends in Cardiovascular Medicine 32 (2022) 399–405

very little change in TC levels [25]. A subsequent meta-analysis vasodilatory effect of adenosine, but it has also been shown to im-
showed that coffee consumption resulted in an increase in TC, prove endothelial function as assessed by brachial artery flow me-
LDL, triglycerides, although the increases were more pronounced diated dilation (FMD) [37,38].
in those with hyperlipidemia, unfiltered coffee consumption, and A meta-analysis showed that moderate coffee consumption (>1
high daily intake (>6 cups/day) [26]. In a UK Biobank study, cup/day in United States, or >2 cups/ day in Europe) resulted in
each additional cup of coffee resulted in significantly higher TC, a significant reduction in the risk of CHD, when compared with
LDL and high density lipoprotein (HDL) levels, when compared to minimal coffee consumption (<1 cup/day in United States, or ≤
non-drinkers. However triglyceride levels were significantly lower. 2 cups/ day in Europe) [39]. A separate meta-analysis showed a ‘U
Espresso drinkers had higher LDL levels, which was not seen in in- shaped’ inverse relationship between coffee consumption and CHD.
stant coffee drinkers [9]. However, a large Italian cohort study re- All categories of coffee consumption were associated with lower
ported that higher espresso consumption did not significantly alter CHD risk, with the most significant reduction seen in those con-
lipid levels [27]. suming a median of 3.5 cups/day [40]. In contrast, a meta-analysis
The effects of tea on serum lipids are more consistent, with the of 17 studies showed that coffee consumption > 4 cups/day sig-
bulk of evidence based on green tea and /or catechin consumption. nificantly increased the risk of CHD events (RR 1.48), whereas 2–3
Separate meta-analyses had shown significant reductions in TC and cups/day had no effect on risk [41]. Pathophysiologic correlations
LDL levels [19,20]. The results were not influenced by the number between coffee and CT coronary artery calcium (CAC] scores had
of cups, study duration or individual health status. In a recent UK also shown favourable outcomes with coffee consumption. Coffee
biobank study, higher tea consumption, when compared to non- intake at all levels protects against coronary artery calcification,
tea drinker, resulted in significantly lower TC and LDL levels, along with the greatest benefit seen in those who consume > 3 cups/day
with higher HDL levels. These associations were similar for both (OR 0.33; CI 0.17–0.65). As expected, any potentially beneficial ef-
black and green tea [9]. fects from coffee is negated by smoking [42].
A large prospective cohort study showed that tea consumption
at all levels was protective against CHD events [43]. In the MESA
Diabetes mellitus
study, regular tea drinkers (≥1 cup/day) had significantly slower
progression of CT CAC score when compared with never drinkers,
The effects of coffee on glucose homeostasis are complex. Caf-
which also correlated with a significantly lower incidence of CVD
feine has been shown to reduce insulin sensitivity, possibly related
events [44]. A recent study, however, found that those in the high-
to adrenaline release [28]. Adenosine A1 receptor antagonism from
est tertile of tea and caffeine consumption had elevated risk of
acute coffee intake (within 1–3 h) can reduced skeletal muscle glu-
CVD. The authors postulated that the negative results could possi-
cose uptake [29]. Coffee intake can increase secretion of gastric in-
bly be related to black tea being the predominant locally consumed
hibitory polypeptide (GIP) and decrease secretion of glucagon-like
tea, as well as the addition of sugar to tea [45].
peptide-1 (GLP-1), leading to reduced intestinal glucose absorption
In acute myocardial infarction (MI) survivors, a meta-analysis
[30]. Furthermore, coffee polyphenols have important antioxidant
reported that habitual coffee consumption was associated with
and anti-inflammatory effects that can affect glucose metabolism
a reduced risk of mortality. Compared with non-drinkers, light
and insulin sensitivity [30].
drinkers (1–2 cups/day) had a 21% relative risk reduction, whereas
Several meta-analyses have demonstrated the beneficial effect
heavy drinkers (>2 cups/day) had a 46% risk reduction [46]. In
of coffee on reducing the incidence of type 2 diabetes mellitus
contrast, a prospective study of 2172 MI survivors from 6 Greek
(T2DM). In a meta-analysis, each additional coffee cup/day was
hospitals had shown that 1–2 cups of coffee per day, when com-
associated with an incremental reduction in T2DM risk. This was
pared to non-drinkers, significantly increased the risk of acute
seen in both caffeinated and de-caffeinated coffee, with the lowest
coronary syndrome (ACS) events over a 10 year period (OR 1.35)
risk seen in those consuming 6 cups/day (RR 0.67) [31]. A recent
[47]
review showed a 6% risk reduction in T2DM for each cup/ day in-
crease in coffee consumption; with the lowest risk seen in those
at the highest category (5 cup/day) of coffee consumption (RR 0.7)
Cardiac arrhythmias
[32].
Amongst T2DM patients, regular caffeinated coffee consumption
Atrial arrhythmias
of ≥ 4 cups/day did not increase the risk of CVD or mortality [33].
Elderly (>60 years) patients with pre-existing T2DM also demon-
Current evidence suggests that coffee consumption is safe and
strated significant improvement in fasting blood glucose with >3
may even protect against atrial arrhythmias, in particular atrial
cups of coffee/day [34].
fibrillation (AF) [1,2]. The postulated mechanisms conferring pro-
Green tea consumption has also been shown to reduce the
tection against arrhythmias are due to cardiomyocyte adenosine
risk of T2DM, which is possibly mediated through the anti-oxidant
receptor antagonism by caffeine, and antioxidant effects [1,2]. A
and anti-inflammatory effects of catechins [35]. In a meta-analysis,
meta-analysis showed that AF incidence decreased by 6% for ev-
green tea resulted in a significant reduction in fasting blood glu-
ery 300 mg/day increment in caffeine intake [48]. A recent meta-
cose levels, particularly in those < 55 years and in Asian popu-
analysis found that intermediate levels of coffee consumption (1–7
lations [35]. A 2020 meta-analysis showed that green tea signifi-
cups/week) resulted in significant reduction in AF incidence, when
cantly reduces the incidence of T2DM; however black tea did not.
compared with non-consumers or those with higher levels of in-
The authors concluded that different types of tea have varying pro-
take (>1 cup/ day) [49]. A prospective study found that caffeine
tective mechanisms on metabolic syndrome although the explana-
intake in excess of 320 mg/day decreases AF incidence compared
tion for this observation is unclear [36].
to lower levels of consumption. Slow caffeine metabolizers from
CYP1A2 gene polymorphisms had further AF reduction on univari-
Coronary heart disease ate analysis, although this was not significant on multivariate anal-
ysis [50].
Studies on coffee and the risk of coronary heart disease (CHD) Green tea consumption has also been found to protect again in-
have been mixed although the majority suggest reduced risk at cident AF in a dose dependent manner (OR 0.35) [51]. A cohort
moderate levels of consumption. Caffeine antagonizes the coronary study of participants who underwent 24 hour Holter monitoring

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D. Chieng and P.M. Kistler Trends in Cardiovascular Medicine 32 (2022) 399–405

showed no correlation between tea intake with atrial or ventricu- cups/day (RR: 0.79) [64]. Moderate green and black tea consump-
lar ectopy [52]. tion, at up to 3 cups/day, had also been shown to protect against
stroke (RR 0.76) [65].
Ventricular arrhythmias / sudden cardiac death

Data examining the association between coffee/ tea and ven- Cardiovascular disease (CVD) and all cause mortality
tricular arrhythmia (VA), ventricular tachycardia (VT) and sudden
cardiac death (SCD) are limited to small scale studies, with the ma- Large scale population studies and meta-analyses have shown
jority showing no increased risk [1]. A meta-analysis showed that that moderate coffee consumption results in a reduced risk of car-
caffeine consumption had no impact on ventricular ectopy [53]. diovascular and total mortality. The NIH–AARP Diet and Health
Patients with cardiomyopathy at high risk of VA who consumed Study demonstrated that both caffeinated and decaffeinated cof-
500 mg caffeine did not experience any significant difference in fee consumption was inversely associated with all cause mortality,
ventricular ectopy/ non sustained VT, when compared to those including mortality from CHD. The greatest benefit was seen with
on placebo [54]. In MI survivors, regular caffeine intake (mean 4–5 cups of coffee/day [66]. A meta-analysis showed that intakes
353 mg/day) resulted in improved heart rate variability without in- between 3 and 5 cups/day had the most significant reduction in
creasing arrhythmia risk [55]. Moderate levels of tea consumption CVD mortality [67]. A recent meta-analysis of 3,852,651 subjects
in MI survivors (14 cups/week) resulted in a significant reduction showed the greatest risk reduction in all-cause mortality with 3.5
in VA (OR 0.7) [56]. cups of coffee a day (RR 0.85), and in CVD mortality with 2.5 cups
Although physicians commonly advise caffeine abstinence in of coffee a day (RR 0.83). Subgroup analyses showed a more pro-
patients with arrhythmias, there is minimal evidence to support nounced inverse association between coffee and mortality in Euro-
this [1]. Patients should not be advised to stop drinking coffee un- pean and Asian populations [68].
less an individual reports a clear temporal relationship. A meta-analysis showed that higher green tea consumption sig-
nificantly reduced both CVD and all cause mortality. The relative
Heart failure risk reduction between the highest and lowest category of green
tea intake for CVD and all cause mortality was 33% and 20% respec-
Coffee and tea consumption may be associated with a reduc- tively. Furthermore, each cup per day increase in green tea was as-
tion in the risk of incident heart failure (HF). In a meta-analysis, sociated with 5% lower CVD mortality, and 4% lower all cause mor-
a J-shaped relationship between coffee and HF was observed, with tality. A significant inverse association was seen for black tea con-
the strongest benefit of 11% risk reduction seen in those who con- sumption and all cause mortality, but not for CVD mortality [69].
sumed 4 cups/day of coffee [57]. A recent study on participants A separate meta-analysis showed that an increase in tea consump-
in the Framingham Heart Study (FHS) found that higher coffee in- tion by 3 cups per day significantly reduced the risk of both CVD
take significantly reduced the risk of HF, which was validated in and all cause mortality [70].
the same study in participants from the large scale Cardiovascular
Heart Study, and the Atherosclerosis Risk in Communities Study. Limitations
Overall, the lowest HF incidence was seen in those who consumed
2 cups/day. Increased caffeine intake (coffee/black tea) was also Epidemiological studies on coffee and tea are potentially con-
significantly associated with reduced HF [58]. founded by other lifestyle factors, and if unaccounted for can lead
Coffee consumption may improve functional capacity in those to erroneous conclusions [3]. Beverage consumption may reflect
with existing heart failure. Intravenous caffeine at 4 mg/kg (ap- other dietary or behavioral characteristics in geographic areas re-
proximately 2 cups of coffee) significantly increased mean exercise sponsible for the observed effect rather than a direct effect of the
time and peak minute ventilation, with no effect on peak oxygen beverage itself. Studies may differ in cup sizes, type of coffee/ tea
consumption [59]. Recent studies have also examined the effect of used, or amounts of sugar/ milk/ sweetener added. Generally, stud-
coffee consumption on left ventricular function, as assessed using ies rely on self reporting for beverage types and numbers which
multi-modality imaging. Low-to-moderate daily coffee consump- may vary over time. Self selection bias may be present where
tion (1–4 cups/day) was associated with improvements in global people would modify caffeine intake based on perceived cardio-
longitudinal strain (GLS), and diastolic function on echocardiogra- vascular symptoms. In a UK Biobank study, those with angina or
phy, compared to non-drinkers. High daily coffee consumption of arrhythmia were less likely to have caffeinated coffee, and more
>4 cups/day, however, was associated with worse left ventricular likely to consume decaffeinated coffee [71]. Mendelian randomiza-
ejection fraction (EF) [60]. In a cardiac magnetic resonance imaging tion studies have become increasingly popular where genetic vari-
study, higher coffee consumption was positively correlated with ants, which increase (or decrease) the propensity for people to
improved EF and late diastolic filling rates [61]. consume caffeine, are used as proxy variables for actual caffeine
intake [21]. However, these findings are potentially confounded by
Cerebrovascular disease pleiotropic genetic variants [3].

Acute physiological effect of caffeine include cerebral vasocon-

striction through adenosine receptor blockade [2]. However, the Future directions
majority of studies have thus far shown that tea/ coffee consump-
tion reduces the incidence of TIAs and stroke. This is likely at- There is a lack of evidence on alternative coffee/ tea types, in-
tributable to the polyphenols, which are associated with improved cluding matcha/ oolong teas, on various cardiovascular outcomes.
endothelial function, increased NO bioavailability, and favorable The interactions between genetic polymorphisms that affect caf-
lipid and glucose profiles [62]. feine metabolism, polymorphisms that affect CVD risk (such as AF
A meta-analysis of population-based studies showed that coffee polygenic risk scores), and coffee and tea consumption, remains to
intake of up to 6 cups/day was associated with a significant re- be explored. Current evidence supports the safety of habitual cof-
duction in stroke risk. The lowest risk was seen in those who con- fee and tea consumption at 2–3 cups per day; however random-
sumed 3–4 cups/day [63]. This finding was corroborated by a sep- ized studies would be required before regular consumption is pre-
arate meta-analysis, with the greatest risk reduction seen in 3–6 scribed in non-drinkers.

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D. Chieng and P.M. Kistler Trends in Cardiovascular Medicine 32 (2022) 399–405

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