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Coffee consumption associated with lower all-cause mortality

Clinical Question:
Is coffee consumption associated with increased or decreased all-cause mortality?

Bottom Line:
In this study, coffee consumption was associated with significantly lower all-cause mortality. So, for optimal health, I'll start my day with coffee. Then, following the advice of other researchers, I'll eat a little dark chocolate with lunch and drink red wine with dinner. Sounds like a plan! (LOE = 2b)

Reference:
Freedman ND, Park Y, Abnet CC, Hollenbeck AR, Sinha R. Association of coffee drinking with total and cause-specific mortality. N Engl J Med 2012;366(20):1891-1904.  [PMID:22591295]

Study Design:
Cohort (prospective)

Funding:
Government

Setting:
Population-based

Synopsis:
In previous studies, coffee has been implicated as a cause of adverse cardiovascular events and cancer. However, studies were often not prospective, and often did not control for possible confounding variables like smoking. These researchers used data from the NIH-AARP Diet and Health Study, a large prospective cohort that gathered baseline data on 566,401 members of the American Association of Retired Persons between 1995 and 1996. For the current study, those with heart disease, stroke, cancer, or who did not provide information on tobacco use were excluded, as well as those who had a surrogate complete the survey and those with very low or high calorie intakes. That left 229,119 men and 173,141 women for the current study. The survey provided detailed information on diet and on coffee consumption, which was varied in a subset of 1953 participants with a 24-hour dietary recall. Patients were followed up for up to 13 years and linked to a national death registry and state cancer registries to determine their cause of death. Perhaps not surprisingly, coffee drinkers were much more likely to use tobacco, especially heavy coffee drinkers, and were also more likely to use alcohol. Thus, in the unadjusted analysis, increasing coffee consumption was associated with increased all-cause, cancer, and heart disease mortalities, and this persisted even after adjusting for age. However, after adjusting for tobacco use, race, education, alcohol, marital status, physical activity, and a variety of other potential confounders, coffee appeared to actually be protective. Increasing coffee consumption, especially 2 or more cups per day, was associated with significantly lower all-cause mortality (hazard ratios = 0.87 to 0.9 for 2 to 3 cups, 0.84 to 0.88 for 4 or 5 cups, and 0.85 to 0.9 for 6 or more cups; range is for men and women, respectively). The hazard ratios were generally similar between men and women, although the diffferences did not reach statistical significance in women for some outcomes because of the smaller sample size. Benefits were seen for a broad range of health outcomes, including stroke, injuries, and accidents (staying awake on the road?), respiratory disease, heart disease, and diabetes mellitus. And best of all, the benefit is greater for those in good health and those who drink more alcohol.

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