Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Cardiovascular effects of caffeine and caffeinated beverages

Elsa-Grace Giardina, MD, MS, FACC, FACP, FAHA
Section Editor
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Deputy Editors
Howard Libman, MD, FACP
Gordon M Saperia, MD, FACC


Consumed in coffee, tea, and soft drinks, caffeine is the most widely used pharmacologically active substance in the world. Exposure to caffeine is generally of long duration, and the prevalence of exposure is very high (>80 percent) in most countries. The main sources of caffeine and the amount found in each are summarized in the table (table 1). Coffee and tea average 100 mg of caffeine per serving, colas about 50 mg per serving, and “energy drinks” as much as 250 mg per serving.

The effects of caffeine on the cardiovascular system are the subject of this review. Non-cardiovascular effects of caffeine are discussed in detail elsewhere. (See "Benefits and risks of caffeine and caffeinated beverages".)


This topic focuses on the cardiovascular effects of caffeine. Most of the relevant studies of chronic caffeine ingestion have been performed in coffee drinkers. While coffee contains other compounds such as chlorogenic acid, potassium, magnesium, niacin, and lignans, we are not aware of evidence to suggest that these compounds influence cardiovascular outcomes in the amounts consumed by coffee drinkers. (See "Benefits and risks of caffeine and caffeinated beverages", section on 'Active components and metabolism'.)


Caffeine is absorbed after oral, rectal, or parenteral administration, and maximal concentration is achieved in one hour [1]. Oral bioavailability is almost 100 percent; food slows the rate of absorption but does not limit the extent. Any effects on the cardiovascular system should return to baseline after about 10 and 60 hours, as the half-life is 2 to 12 hours [2]. (See 'Cardiovascular effects' below.)

The apparent volume of distribution is between 0.4 and 0.6 L/kg, and less than 40 percent is bound to plasma proteins. Caffeine is distributed into all body compartments; it crosses the placenta and passes into breast milk.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 19, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Rall TW. The Methylxanthines. In: Goodman and Gilman's Pharmacological Basis of Therapeutics, 9th ed, Hardman J (Ed), McGraw-Hill, New York 1993. p.1663.
  2. Hartley TR, Sung BH, Pincomb GA, et al. Hypertension risk status and effect of caffeine on blood pressure. Hypertension 2000; 36:137.
  3. Gilbert RM. Caffeine consumption. In: The methylxanthine beverages and foods: chemistry, consumption, and health effects, Spiller GA (Ed), Alan R Liss, New York 1984. p.185.
  4. Robertson D, Wade D, Workman R, et al. Tolerance to the humoral and hemodynamic effects of caffeine in man. J Clin Invest 1981; 67:1111.
  5. Carrillo JA, Benitez J. CYP1A2 activity, gender and smoking, as variables influencing the toxicity of caffeine. Br J Clin Pharmacol 1996; 41:605.
  6. Cornelis MC, El-Sohemy A, Kabagambe EK, Campos H. Coffee, CYP1A2 genotype, and risk of myocardial infarction. JAMA 2006; 295:1135.
  7. Scholz H. Inotropic drugs and their mechanisms of action. J Am Coll Cardiol 1984; 4:389.
  8. Wennmalm A, Wennmalm M. Coffee, catecholamines and cardiac arrhythmia. Clin Physiol 1989; 9:201.
  9. Konishi M, Kurihara S. Effects of caffeine on intracellular calcium concentrations in frog skeletal muscle fibres. J Physiol 1987; 383:269.
  10. Hess P, Wier WG. Excitation-contraction coupling in cardiac Purkinje fibers. Effects of caffeine on the intracellular [Ca2+] transient, membrane currents, and contraction. J Gen Physiol 1984; 83:417.
  11. Eisner DA, Valdeolmillos M. The mechanism of the increase of tonic tension produced by caffeine in sheep cardiac Purkinje fibres. J Physiol 1985; 364:313.
  12. Nieman CJ, Eisner DA. Effects of caffeine, tetracaine, and ryanodine on calcium-dependent oscillations in sheep cardiac Purkinje fibers. J Gen Physiol 1985; 86:877.
  13. Vassalle M, Di Gennaro M. Caffeine actions on currents induced by calcium-overload in Purkinje fibers. Eur J Pharmacol 1984; 106:121.
  14. Ishida S, Ito M, Takahashi N, et al. Caffeine induces ventricular tachyarrhythmias possibly due to triggered activity in rabbits in vivo. Jpn Circ J 1996; 60:157.
  15. Paspa P, Vassalle M. Mechanism of caffeine-induced arrhythmias in canine cardiac Purkinje fibers. Am J Cardiol 1984; 53:313.
  16. Corti R, Binggeli C, Sudano I, et al. Coffee acutely increases sympathetic nerve activity and blood pressure independently of caffeine content: role of habitual versus nonhabitual drinking. Circulation 2002; 106:2935.
  17. Nehlig A, Daval JL, Debry G. Caffeine and the central nervous system: mechanisms of action, biochemical, metabolic and psychostimulant effects. Brain Res Brain Res Rev 1992; 17:139.
  18. Ammon HP. Biochemical mechanism of caffeine tolerance. Arch Pharm (Weinheim) 1991; 324:261.
  19. Chelsky LB, Cutler JE, Griffith K, et al. Caffeine and ventricular arrhythmias. An electrophysiological approach. JAMA 1990; 264:2236.
  20. Newcombe PF, Renton KW, Rautaharju PM, et al. High-dose caffeine and cardiac rate and rhythm in normal subjects. Chest 1988; 94:90.
  21. Myers MG. Caffeine and cardiac arrhythmias. Ann Intern Med 1991; 114:147.
  22. Frost L, Vestergaard P. Caffeine and risk of atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Am J Clin Nutr 2005; 81:578.
  23. Graboys TB, Blatt CM, Lown B. The effect of caffeine on ventricular ectopic activity in patients with malignant ventricular arrhythmia. Arch Intern Med 1989; 149:637.
  24. Caldeira D, Martins C, Alves LB, et al. Caffeine does not increase the risk of atrial fibrillation: a systematic review and meta-analysis of observational studies. Heart 2013; 99:1383.
  25. Klatsky AL, Hasan AS, Armstrong MA, et al. Coffee, caffeine, and risk of hospitalization for arrhythmias. Perm J 2011; 15:19.
  26. Avcı S, Sarıkaya R, Büyükcam F. Death of a young man after overuse of energy drink. Am J Emerg Med 2013; 31:1624.e3.
  27. Ciszowski K, Biedroń W, Gomólka E. Acute caffeine poisoning resulting in atrial fibrillation after guarana extract overdose. Przegl Lek 2014; 71:495.
  28. Ward AE, Lipshultz SE, Fisher SD. Energy drink-induced near-fatal ventricular arrhythmia prevented by an intracardiac defibrillator decades after operative "repair" of tetralogy of Fallot. Am J Cardiol 2014; 114:1124.
  29. Seifert SM, Seifert SA, Schaechter JL, et al. An analysis of energy-drink toxicity in the National Poison Data System. Clin Toxicol (Phila) 2013; 51:566.
  30. Rudolph T, Knudsen K. A case of fatal caffeine poisoning. Acta Anaesthesiol Scand 2010; 54:521.
  31. Dixit S, Stein PK, Dewland TA, et al. Consumption of Caffeinated Products and Cardiac Ectopy. J Am Heart Assoc 2016; 5.
  32. Cheng M, Hu Z, Lu X, et al. Caffeine intake and atrial fibrillation incidence: dose response meta-analysis of prospective cohort studies. Can J Cardiol 2014; 30:448.
  33. Newby DE, Neilson JM, Jarvie DR, Boon NA. Caffeine restriction has no role in the management of patients with symptomatic idiopathic ventricular premature beats. Heart 1996; 76:355.
  34. Zuchinali P, Souza GC, Pimentel M, et al. Short-term Effects of High-Dose Caffeine on Cardiac Arrhythmias in Patients With Heart Failure: A Randomized Clinical Trial. JAMA Intern Med 2016; 176:1752.
  35. Lemery R, Pecarskie A, Bernick J, et al. A prospective placebo controlled randomized study of caffeine in patients with supraventricular tachycardia undergoing electrophysiologic testing. J Cardiovasc Electrophysiol 2015; 26:1.
  36. Curatolo PW, Robertson D. The health consequences of caffeine. Ann Intern Med 1983; 98:641.
  37. Freestone S, Ramsay LE. Effect of coffee and cigarette smoking on the blood pressure of untreated and diuretic-treated hypertensive patients. Am J Med 1982; 73:348.
  38. Sharp DS, Benowitz NL. Pharmacoepidemiology of the effect of caffeine on blood pressure. Clin Pharmacol Ther 1990; 47:57.
  39. Jeong DU, Dimsdale JE. The effects of caffeine on blood pressure in the work environment. Am J Hypertens 1990; 3:749.
  40. Sudano I, Spieker L, Binggeli C, et al. Coffee blunts mental stress-induced blood pressure increase in habitual but not in nonhabitual coffee drinkers. Hypertension 2005; 46:521.
  41. Rakic V, Burke V, Beilin LJ. Effects of coffee on ambulatory blood pressure in older men and women: A randomized controlled trial. Hypertension 1999; 33:869.
  42. Steffen M, Kuhle C, Hensrud D, et al. The effect of coffee consumption on blood pressure and the development of hypertension: a systematic review and meta-analysis. J Hypertens 2012; 30:2245.
  43. Noordzij M, Uiterwaal CS, Arends LR, et al. Blood pressure response to chronic intake of coffee and caffeine: a meta-analysis of randomized controlled trials. J Hypertens 2005; 23:921.
  44. van Dusseldorp M, Smits P, Thien T, Katan MB. Effect of decaffeinated versus regular coffee on blood pressure. A 12-week, double-blind trial. Hypertension 1989; 14:563.
  45. Bak AA, Grobbee DE. A randomized study on coffee and blood pressure. J Hum Hypertens 1990; 4:259.
  46. Superko HR, Myll J, DiRicco C, et al. Effects of cessation of caffeinated-coffee consumption on ambulatory and resting blood pressure in men. Am J Cardiol 1994; 73:780.
  47. Taubert D, Roesen R, Schömig E. Effect of cocoa and tea intake on blood pressure: a meta-analysis. Arch Intern Med 2007; 167:626.
  48. James JE. Chronic effects of habitual caffeine consumption on laboratory and ambulatory blood pressure levels. J Cardiovasc Risk 1994; 1:159.
  49. Maughan RJ, Griffin J. Caffeine ingestion and fluid balance: a review. J Hum Nutr Diet 2003; 16:411.
  50. Vlachopoulos C, Kosmopoulou F, Panagiotakos D, et al. Smoking and caffeine have a synergistic detrimental effect on aortic stiffness and wave reflections. J Am Coll Cardiol 2004; 44:1911.
  51. Lopez-Garcia E, van Dam RM, Willett WC, et al. Coffee consumption and coronary heart disease in men and women: a prospective cohort study. Circulation 2006; 113:2045.
  52. Bak AA, Grobbee DE. The effect on serum cholesterol levels of coffee brewed by filtering or boiling. N Engl J Med 1989; 321:1432.
  53. Wei M, Macera CA, Hornung CA, Blair SN. The impact of changes in coffee consumption on serum cholesterol. J Clin Epidemiol 1995; 48:1189.
  54. Lewis CE, Caan B, Funkhouser E, et al. Inconsistent associations of caffeine-containing beverages with blood pressure and with lipoproteins. The CARDIA Study. Coronary Artery Risk Development in Young Adults. Am J Epidemiol 1993; 138:502.
  55. Yukawa GS, Mune M, Otani H, et al. Effects of coffee consumption on oxidative susceptibility of low-density lipoproteins and serum lipid levels in humans. Biochemistry (Mosc) 2004; 69:70.
  56. Jee SH, He J, Appel LJ, et al. Coffee consumption and serum lipids: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol 2001; 153:353.
  57. de Roos B, Katan MB. Possible mechanisms underlying the cholesterol-raising effect of the coffee diterpene cafestol. Curr Opin Lipidol 1999; 10:41.
  58. Grobbee DE, Rimm EB, Giovannucci E, et al. Coffee, caffeine, and cardiovascular disease in men. N Engl J Med 1990; 323:1026.
  59. Kleemola P, Jousilahti P, Pietinen P, et al. Coffee consumption and the risk of coronary heart disease and death. Arch Intern Med 2000; 160:3393.
  60. Ding M, Bhupathiraju SN, Satija A, et al. Long-term coffee consumption and risk of cardiovascular disease: a systematic review and a dose-response meta-analysis of prospective cohort studies. Circulation 2014; 129:643.
  61. Larsson SC, Virtamo J, Wolk A. Coffee consumption and risk of stroke in women. Stroke 2011; 42:908.
  62. Lopez-Garcia E, Rodriguez-Artalejo F, Rexrode KM, et al. Coffee consumption and risk of stroke in women. Circulation 2009; 119:1116.
  63. Larsson SC, Männistö S, Virtanen MJ, et al. Coffee and tea consumption and risk of stroke subtypes in male smokers. Stroke 2008; 39:1681.
  64. Larsson SC, Orsini N. Coffee consumption and risk of stroke: a dose-response meta-analysis of prospective studies. Am J Epidemiol 2011; 174:993.
  65. Mostofsky E, Schlaug G, Mukamal KJ, et al. Coffee and acute ischemic stroke onset: the Stroke Onset Study. Neurology 2010; 75:1583.
  66. Lopez-Garcia E, van Dam RM, Li TY, et al. The relationship of coffee consumption with mortality. Ann Intern Med 2008; 148:904.
  67. Gardener H, Rundek T, Wright CB, et al. Coffee and tea consumption are inversely associated with mortality in a multiethnic urban population. J Nutr 2013; 143:1299.
  68. Freedman ND, Park Y, Abnet CC, et al. Association of coffee drinking with total and cause-specific mortality. N Engl J Med 2012; 366:1891.
  69. Park SY, Freedman ND, Haiman CA, et al. Association of Coffee Consumption With Total and Cause-Specific Mortality Among Nonwhite Populations. Ann Intern Med 2017; 167:228.
  70. Gunter MJ, Murphy N, Cross AJ, et al. Coffee Drinking and Mortality in 10 European Countries: A Multinational Cohort Study. Ann Intern Med 2017; 167:236.
  71. Liu J, Sui X, Lavie CJ, et al. Association of coffee consumption with all-cause and cardiovascular disease mortality. Mayo Clin Proc 2013; 88:1066.
  72. de Vreede-Swagemakers JJ, Gorgels AP, Weijenberg MP, et al. Risk indicators for out-of-hospital cardiac arrest in patients with coronary artery disease. J Clin Epidemiol 1999; 52:601.