Moderate coffee intake may lower heart failure risk

By Pooja Toshniwal PahariaReviewed by Susha Cheriyedath, M.Sc.Mar 24 2026

Drinking 2 to 4 cups of coffee a day was linked to 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 being moderation, not excess.

Review: Habitual coffee consumption and risk of incident 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 the Journal of Health, Population, and Nutrition reports that moderate coffee consumption may lower the risk of developing heart failure (HF), a major cause of hospitalization and mortality worldwide.

Analyzing data from over 650,000 participants across seven prospective cohorts, researchers found that drinking two to four cups daily was associated with a modest reduction in heart failure risk. The findings also suggest a nuanced, dose-dependent relationship, highlighting potential benefits beyond caffeine alone, particularly at moderate intake levels. These findings reinforce growing interest in dietary factors as modifiable drivers of HF risk.

HF remains a major global health burden, with rising prevalence and costs, particularly in ageing populations. Although coffee is widely consumed and rich in bioactive compounds with antioxidant and anti-inflammatory effects, its role in HF prevention remains unclear. Evidence suggests cardiovascular benefits with moderate intake, but HF-specific data are limited, and prior meta-analytic evidence was largely based on Nordic populations, reducing generalizability. Differences across coffee subtypes are also underexplored, underscoring the need for more comprehensive analyses.

Systematic Review and Meta-Analysis Methodology

In this systematic review and meta-analysis, researchers assessed the association between coffee intake and risk of new-onset HF.

The team systematically searched PubMed, Scopus, and Embase for prospective cohort studies published between January 2012 and October 2025, with no language restrictions. They supplemented this with manual reference checks.

Eligible studies reported hazard ratios (HRs), relative risks (RR), or odds ratios (ORs) for coffee intake and HF incidence. These records reported coffee intake as cups per day or caffeine intake in milligrams per day, estimated through questionnaires. Researchers defined moderate intake as consuming two to four cups daily and high intake as five or more cups.

The team ascertained HF outcomes using patient health records, hospital discharge data, or clinically reviewed outcome measures, accounting for key confounders such as age and smoking. They excluded ecological, cross-sectional, or case-control studies, duplicate records, and conference abstracts without full texts.

Two reviewers independently extracted data and resolved discrepancies by consensus. They evaluated study quality using the Newcastle-Ottawa Scale (NOS) and graded evidence certainty using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. 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 conducted subgroup analyses by coffee type, region, sex, and population-level characteristics. They explored dose-response relationships with restricted cubic splines and assessed heterogeneity using Cochran's Q and I² statistics. Lastly, the researchers performed multiple sensitivity analyses, including leave-one-out approaches and restrictions to low-bias studies, to confirm the robustness of their findings.

Heart Failure Risk Reduction and Dose Response Results

In total, the team identified 13 relevant studies with seven independent cohorts. These studies reported 20,646 incident HF cases among 656,666 individuals with up to 35 years of follow-up across Sweden, Finland, the United Kingdom (UK), and the United States (US). The pooled analysis showed that consuming two to four cups of coffee daily was linked to a significantly lower risk of HF (HR, 0.93), with minimal variability across studies.

Dose-response analyses suggested a J-shaped pattern, although statistical evidence for non-linearity was borderline. The greatest risk reduction emerged at one to two cups daily (HR, 0.88), while protective effects persisted up to three to four cups per day. However, this benefit diminished at higher intake levels, particularly beyond six cups daily. Stratified analyses demonstrated similar directions of association across Nordic and UK cohorts, while one US cohort showed no clear association, reinforcing that the overall pattern was broadly consistent but not uniform across all settings.

Coffee with or without caffeine showed similar protective associations with HF risk. The findings suggest that non-caffeine compounds, such as chlorogenic acids and polyphenols, may contribute to these benefits. Emerging evidence also indicates that coffee may support beneficial gut microbiota, but this remains a mechanistic hypothesis rather than a direct finding of this meta-analysis.

Evidence Strength and Sensitivity Analysis Findings

The team did not find any publication bias, and multiple sensitivity analyses confirmed the stability of the results. However, the overall evidence certainty was rated as low, underscoring the need for further large-scale, well-controlled studies.

Nonetheless, the findings suggest that moderate coffee intake, including decaffeinated varieties, may be compatible with a heart-healthy dietary pattern, rather than serving as a standalone strategy to reduce HF risk.

Clinical Implications and Dietary Recommendations

The findings suggest that moderate coffee consumption can be part of a heart-healthy lifestyle, with the greatest benefit seen at around 1 to 4 cups daily, the lowest estimated risk at 1 to 2 cups, and diminishing returns at higher intake. Guidance from the European Food Safety Authority (EFSA), which considers up to 400 mg of caffeine daily safe for most adults, may be broadly consistent with this intake range, although the meta-analysis did not directly test caffeine thresholds.

Notably, decaffeinated coffee appears to offer similar benefits, making it a suitable option for those limiting caffeine intake, although evidence for coffee subtypes comes from within-cohort analyses and still requires confirmation in independent populations.

However, low certainty of evidence and potential residual confounding call for cautious interpretation. Future studies should better define coffee types and brewing methods, track changes in intake over time, and explore mechanisms through biomarker and genetic research, while expanding to more diverse populations.