Drinking 2 to 4 cups of coffee per day was associated with a modest reduction in heart failure risk in this updated meta-analysis, with the lowest estimated risk at 1 to 2 cups, and the strongest message is moderation, not excess.
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Drinking 2 to 4 cups of coffee per day was associated with a moderately lower risk of heart failure in this meta-analysis of prospective cohort studies.
The lowest estimated risk was seen at 1 to 2 cups daily, but the evidence for a true J-shaped dose-response pattern was suggestive and not conclusive.
The available analyzes found similar associations for caffeinated and decaffeinated coffee, suggesting that compounds other than caffeine may also contribute.
The evidence came from observational cohort data and was rated low-certainty, so the results show an association rather than proof that coffee prevents heart failure.
Review: Habitual coffee consumption and risk of heart failure: an updated systematic review and dose-response meta-analysis of prospective cohort studies. Image credit: PeopleImages / Shutterstock
A recent systematic review and meta-analysis published in Journal of Health, Population, and Nutrition reports that moderate coffee consumption may reduce the risk of heart failure (HF), a major cause of hospitalization and mortality worldwide.
Analyzing data from more than 650,000 participants in seven prospective cohorts, researchers found that drinking two to four cups a day was associated with a modest reduction in the risk of heart failure. The findings also suggest a nuanced, dose-dependent relationship, highlighting potential benefits beyond caffeine alone, particularly at moderate levels of intake. These findings reinforce the growing interest in dietary factors as modifiable risk factors for heart failure.
Heart failure remains a major global health burden, with increasing prevalence and cost, particularly in aging populations. Although coffee is widely consumed and rich in bioactive compounds with antioxidant and anti-inflammatory effects, its role in the prevention of heart failure remains unclear. Evidence suggests cardiovascular benefits with moderate intake, but HF-specific data are limited and previous meta-analytic evidence was largely based on Nordic populations, reducing generalizability. Differences between coffee subtypes are also underexplored, highlighting the need for more comprehensive analyses.
Systematic Review and Meta-Analysis Methodology
In this systematic review and meta-analysis, researchers evaluated the relationship between coffee intake and the risk of new-onset heart failure.
The team systematically searched PubMed, Scopus and Embase for prospective cohort studies published between January 2012 and October 2025, without language restrictions. They supplemented this with manual reference checks.
Eligible studies reported hazard ratios (HR), relative risks (RR), or odds ratios (ORs) for coffee intake and heart failure incidence. These records reported coffee intake as cups per day or caffeine intake in milligrams per day, calculated via questionnaires. The researchers defined moderate intake as drinking two to four cups a day and high intake as five or more cups.
The team ascertained heart failure outcomes using patient health records, hospital discharge data or clinically reviewed outcome measures, taking into account key confounders such as age and smoking. They excluded ecological, cross-sectional or case-control studies, duplicate entries and conference abstracts without full texts.
Two reviewers independently extracted data and resolved discrepancies by consensus. They assessed study quality using the Newcastle-Ottawa scale (NOS(DEGREE) context. The reviewers also performed Egger’s regression test and analyzed funnel plots to assess publication bias.
Using random-effects modeling, the researchers generated pooled estimates and performed subgroup analyzes by coffee type, region, gender, and population-level characteristics. They investigated dose–response relationships with restricted cubic spheres and assessed heterogeneity using Cochran’s Q and I² statistics. Finally, the researchers conducted multiple sensitivity analyses, including leave-one-out approaches and restrictions on low-bias studies, to confirm the reliability of their findings.
Heart failure risk reduction and dose-response outcomes
In total, the team identified 13 relevant studies with seven independent groups. These studies reported 20,646 heart failure events among 656,666 subjects with up to 35 years of follow-up in Sweden, Finland, and the United Kingdom (United Kingdom), and the United States (US). Pooled analysis showed that drinking two to four cups of coffee per day was associated with a significantly lower risk of heart failure (HR, 0.93), with minimal variability between studies.
Dose-response analyzes suggested a J-shaped pattern, although statistical evidence for non-linearity was marginal. The greatest risk reduction occurred with one to two cups per day (HR, 0.88), while the protective effects persisted up to three to four cups per day. However, this benefit diminished at higher levels of intake, particularly beyond six cups per day. Stratified analyzes demonstrated similar directions of association between the Scandinavian and UK cohorts, while a US cohort showed no clear association, reinforcing that the overall pattern was broadly consistent but not uniform across settings.
Caffeinated and decaffeinated coffee showed similar protective associations with heart failure risk. The findings suggest that noncaffeinated compounds, such as chlorogenic acids and polyphenols, may contribute to these benefits. Emerging evidence also suggests that coffee may support beneficial gut microbiota, but this remains a mechanistic hypothesis and not a direct finding of this meta-analysis.
Strength and sensitivity of evidence analysis findings
The team found no publication bias, and multiple sensitivity analyzes confirmed the stability of the results. However, the overall certainty of the evidence was assessed as low, highlighting the need for further large-scale, well-controlled studies.
However, the findings suggest that moderate coffee intake, including decaffeinated varieties, may be compatible with a healthy dietary pattern, rather than serving as a stand-alone strategy to reduce heart failure risk.
Clinical Implications and Dietary Recommendations
The findings suggest that moderate coffee consumption may be part of a heart-healthy lifestyle, with the greatest benefit seen at about 1 to 4 cups daily, the lowest estimated risk at 1 to 2 cups, and diminishing returns at higher intake. Guidelines from the European Food Safety Authority (EFSA), which considers up to 400 mg of caffeine per day safe for most adults, may be broadly consistent with this intake range, although the meta-analysis did not directly examine caffeine thresholds.
Specifically, decaffeinated coffee appears to offer similar benefits, making it a suitable choice for those restricting caffeine intake, although data on coffee subtypes are from within-cohort analyzes and still require confirmation in independent populations.
However, the low certainty of the evidence and possible residual confounding require careful interpretation. Future studies should better define types and methods of coffee preparation, track changes in intake over time, and explore mechanisms through biomarker and genetic research, while expanding to more diverse populations.
