Esther Lopez-Garcia, PhD; Rob M. van Dam, PhD; Tricia Y. Li, MD; Fernando Rodriguez-Artalejo, MD, PhD; Frank B. Hu, MD, PhD
Grant Support: Supported by National Institutes of Health research grants CA87969, CA55075, HL34594, and HL60712. Dr. Lopez-Garcia is supported by a contract from the Ramón y Cajal Programme. Dr. Hu is partly supported by an American Heart Association Established Investigator Award.
Potential Financial Conflicts of Interest: None disclosed.
Reproducible Research Statement:Study protocol: Available at http://www.hsph.harvard.edu/hpfs and http://www.channing.harvard.edu/nhs. Statistical code: Not available. Data set: Available subject to approval by the NHS and HPFS committees.
Requests for Single Reprints: Esther Lopez-Garcia, PhD, Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Avenida Arzobispo Morcillo 4, 28029 Madrid, Spain; e-mail, mailto:firstname.lastname@example.org.
Current Author Addresses: Drs. Lopez-Garcia and Rodriguez-Artalejo: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Avenida Arzobispo Morcillo 4, 28029 Madrid, Spain.
Drs. van Dam, Li, and Hu: Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115.
Author Contributions: Conception and design: E. Lopez-Garcia, R.M. van Dam, T.Y. Li, F. Rodriguez-Artalejo, F.B. Hu.
Analysis and interpretation of the data: E. Lopez-Garcia, R.M. van Dam, T.Y. Li, F. Rodriguez-Artalejo, F.B. Hu.
Drafting of the article: E. Lopez-Garcia.
Critical revision of the article for important intellectual content: E. Lopez-Garcia, R.M. van Dam, F. Rodriguez-Artalejo, F.B. Hu.
Final approval of the article: E. Lopez-Garcia, R.M. van Dam, F. Rodriguez-Artalejo, F.B. Hu.
Statistical expertise: E. Lopez-Garcia, T.Y. Li.
Obtaining of funding: F.B. Hu.
Administrative, technical, or logistic support: F. Rodriguez-Artalejo, F.B. Hu.
Lopez-Garcia E., van Dam R., Li T., Rodriguez-Artalejo F., Hu F.; The Relationship of Coffee Consumption with Mortality. Ann Intern Med. 2008;148:904-914. doi: 10.7326/0003-4819-148-12-200806170-00003
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Published: Ann Intern Med. 2008;148(12):904-914.
Coffee consumption has been linked to various beneficial and detrimental health effects, but data on its relation with mortality are sparse.
To assess the association between coffee consumption and mortality from cardiovascular disease (CVD), cancer, and all causes during 18 years of follow-up in men and 24 years of follow-up in women.
Sex-specific Cox proportional hazard models were used to investigate the association between coffee consumption and incidence of all-cause and disease-specific mortality in a prospective cohort study.
Health Professionals Follow-up Study and Nurses' Health Study.
41 736 men and 86 214 women with no history of CVD or cancer at baseline.
Coffee consumption was assessed first in 1986 for men and in 1980 for women and then every 2 to 4 years through 2004. Investigators documented 6888 deaths (2049 due to CVD and 2491 due to cancer) among men and 11 095 deaths (2368 due to CVD and 5011 due to cancer) among women.
After adjustment for age, smoking, and other CVD and cancer risk factors, the relative risks for all-cause mortality in men across categories of coffee consumption (<1 cup per month, 1 cup per month to 4 cups per week, 5 to 7 cups per week, 2 to 3 cups per day, 4 to 5 cups per day, and ≥6 cups per day) were 1.0, 1.07 (95% CI, 0.99 to 1.16), 1.02 (CI, 0.95 to 1.11), 0.97 (CI, 0.89 to 1.05), 0.93 (CI, 0.81 to 1.07), and 0.80 (CI, 0.62 to 1.04), respectively (P for trend = 0.008). For women, the relative risks were 1.0, 0.98 (CI, 0.91 to 1.05), 0.93 (CI, 0.87 to 0.98), 0.82 (CI, 0.77 to 0.87), 0.74 (CI, 0.68 to 0.81), and 0.83 (CI, 0.73 to 0.95), respectively (P for trend < 0.001). This inverse association was mainly due to a moderately reduced risk for CVD mortality and was independent of caffeine intake. By contrast, coffee consumption was not statistically significantly associated with risk for cancer death after adjustment for potential confounders. Decaffeinated coffee consumption was associated with a small reduction in all-cause and CVD mortality.
Coffee consumption was estimated from self-report; thus, some measurement error is inevitable.
Regular coffee consumption was not associated with an increased mortality rate in either men or women. The possibility of a modest benefit of coffee consumption on all-cause and CVD mortality needs to be further investigated.
Todd A. Hilton
June 17, 2008
What's in the Coffee?
Your study on drinking coffee/mortality leaves out one very important piece of information. The people that you studied, did you ever ask them "what" they were putting in their coffee? Everyone knows it's not necessarily whether you drink coffee or not, it's what do people put in their coffee. Obviously not everyone drinks coffee "black." Did you ever ask the respondents what they put in their coffee, i.e. sugar, cream, etc?
Comando Brigata alpina Julia
June 23, 2008
Coffee consumption, iron and mortality.
Lopez-Garcia and colleagues (1) found an inverse association between coffee and all-cause mortality independent of caffeine intake. We suggest that some of the mechanisms involved in this beneficial association might, in part, be related to inhibition of iron absorption by polyphenol compounds present in coffee. The main phenolic compound in coffee, chlorogenic acid, is a potent inhibitor of nonheme iron absorption (2). On the other hand, accumulating evidence suggests that iron plays a role in many life-threatening disorders, such as in the pathogenesis of ischemic heart disease, cancer, diabetes, infectious diseases, liver disease (3, 4) and, generally, in disorders linked to injury induced by reactive oxygen species (5), thus suggesting that iron can be a factor in the aging process (3). Therefore, the increased intake of polyphenol compounds present in coffee may maintain a relatively lower iron status and thus reduce all-cause mortality.
Luca Mascitelli, Medical Service Comando Brigata alpina "Julia", Udine, Italy
Francesca Pezzetta, Cardiology Service Ospedale di Tolmezzo, Tolmezzo, Italy
Mark R. Goldstein, Fountain Medical Court Bonita Springs, FL, USA
1. Lopez-Garcia E, van Dam RM, Li TY, Rodriguez-Artalejo F, Hu FB. The relationship of coffee consumption with mortality. Ann Intern Med 2008; 148: 904-14.
2. Fleming DJ, Jacques PF, Dallal GE, Tucker KL, Wilson PW, Wood RJ. Dietary determinants of iron stores in a free-living elderly population: The Framingham Heart Study. Am J Clin Nutr 1998; 67: 722-33.
3. Mascitelli L, Pezzetta F, Sullivan JL. Why women live longer than men: sex differences in longevity. Gend Med 2006; 3: 341.
4. Mascitelli L, Pezzetta F, Sullivan JL. Putative hepatoprotective effects of coffee. Aliment Pharmacol Ther 2008; 27: 90-1.
5. Emerit J, Beaumont C, Trivin F. Iron metabolism, free radicals, and oxidative injury. Biomed Pharmacother 2001; 55: 333-339.
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