Abstract
BACKGROUND: Coffee is among the most widely consumed beverages globally, yet evidence specifically examining its association with heart failure (HF) risk remains limited. The only dedicated meta-analysis on this topic was published in 2012. We conducted an updated systematic review and dose-response meta-analysis to comprehensively evaluate the association between coffee consumption and incident HF. METHODS: We searched PubMed, Embase and Scopus from January 2012 through October 2025 to update the original meta-analysis. Prospective cohort studies reporting hazard ratios for coffee consumption and incident HF were included. Random-effects models were used to pool estimates. Subgroup analyses were planned to examine effects by sex, geographic region, coffee type, and population characteristics where possible. Certainty of evidence was assessed using GRADE. RESULTS: Thirteen studies comprising 656,666 participants and 20,646 HF events were identified. Pooled analysis of 7 independent cohorts demonstrated that moderate coffee consumption (2-4 cups/day) was associated with significantly reduced HF risk (HR 0.925; 95% CI 0.882-0.971; P = 0.002) with negligible heterogeneity (I²=0%). A J-shaped dose-response pattern was suggested, although the test for non-linearity was borderline significant (P = 0.066), with maximal benefit observed at 1-2 cups/day. Within-cohort analyses indicated similar associations for caffeinated and decaffeinated coffee. No evidence of publication bias was detected (Egger's P = 0.99). Certainty of evidence was rated as low. CONCLUSIONS: This updated meta-analysis suggests moderate coffee consumption is linked to lower incident heart failure risk, though certainty is low. Associations observed within-cohort analyses were similar for caffeinated and decaffeinated coffee, indicating moderate intake may be compatible within heart-healthy dietary patterns. REVIEW REGISTRATION: (PROSPERO Registration ID: CRD420251269118).