Did heart failure require this former caffeine junkie to give up a morning coffee fix?

For my entire professional career, it seemed like the fuel that drove my ambition and my success was a combination of adrenaline rushes and a steady stream of caffeine.  No wonder I was always in motion and found it hard sometimes to sleep at night!

In previous posts, I have talked about the adrenaline withdrawal pangs I suffered when I started to take beta blockers.  These are drugs that block adrenaline, a substance that damages the heart.  I miss those adrenaline rushes because they made me feel like I could conquer any obstacle in my path.  But I now know that the adrenaline that fed my career achievements also had the unfortunate result of stressing and weakening my heart.
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If adrenaline made me feel like I could accomplish miracles, caffeine was the substance that fueled my drive.   In the offices I worked in, we had a coffee maker that always seemed to be in a brewing status.  It didn’t matter to me if the coffee was a premium blend or the brand that was on sale at the grocery store.  I used to joke that my definition of a good cup of coffee was one that jump-started my heart and accelerated my pace to hyperactive mode.  Little did I know that the joke would eventually be on me and that I would need an actual pacemaker to jump-start my heart. 

When my heart failure worsened, I wondered if there was any danger to my heart in having just one cup of coffee each day.  After all, if I had to give up adrenaline, would I also need to give up the jolt of coffee that served to supplement the adrenaline.  I really hated to go cold turkey on something that I really did love – apart from the energy jolt, I just like the taste of coffee as I leisurely read the newspaper in the morning.   

Happily, I found an article from 2016 on cardiosmart.org, a website of the American College of Cardiology.  The article was entitled “Despite concerns, caffeine is OK for patients with heart failure.”  Thank God – finally something that I don’t have to dismiss from my diet!  But I also did a double take at the sub-headline that said: “Moderate caffeine consumption may not be as dangerous as initially believed.”  Not as dangerous seemed like a bit of a qualification, so was there a need for caution with caffeine consumption?

The first few paragraphs of the article were music to my eyes.
“Many people with heart failure are advised to avoid coffee because of fears that caffeine might provoke an arrhythmia. Now a rare example of a randomized controlled trial in the field offers some assuring evidence that these patients can safely drink coffee.

• The health effects of coffee have been the subject of considerable debate, including wildly disparate views suggesting that coffee may be either beneficial or harmful. * * * Much of the debate has centered on the role of caffeine. Now a small randomized controlled trial sheds light on the effect of coffee in an important patient population.”

 
This was welcome news for two reasons.  First, someone finally decided to actually do some testing to see if the arrhythmia fears were valid, and not just jump to an unproven conclusion.  Second, experts were referring to heart failure patients, a population largely ignored in a world defined by achievement and success, as an important patient population!  Score one for the cardio rejects!
 
Why was the medical community so adamant that coffee consumption could provoke an arrhythmia prior to the study referred to by Cardiosmart?   The Verwellhealth.com website has a good explanation in their January 24, 2019 article entitled Coffee and Heart Disease.  It provides the following explanation for the previous discrepancy:

• Some earlier studies did not take other heart disease risk factors into sufficient account, such as lack of exercise and smoking. More recent studies have taken care to control for these confounding risk factors. These more recent studies have suggested that, when consumed in moderation , coffee does not increase cardiac risk.

 
Of course, the word moderation also suggests that there must be restraint or balance implemented by the heart failure patient.  So what limitations might the heart failure patient want to impose on his or her coffee consumption?  The article has this advice in the paragraph on Coffee and Heart Failure:

• A recent meta-analysis suggests that people who drink 1 to 4 cups of coffee per day have a reduced risk of developing heart failure.  This apparent benefit of drinking coffee is lost when five or more cups of coffee are consumed per day.

While 1 to 4 cups may reduce the risk of developing heart failure, I do not find this helpful in addressing what damage coffee might do to the patient who already has heart failure.   And even if it is okay for current heart failure patients to drink coffee, are there any caveats to the findings?  For the answers to these questions, I returned to the cardiosmart article which discussed the study and indicated it was okay for heart failure patients to drink coffee.   The last paragraph of the article saysL
 
However, it’s important to note that this study only applies to patients with heart failure caused by left ventricular systolic dysfunction. Also, the trial tested the effects of 500 mg of caffeine—the equivalent to 2.5–5 cups of coffee, depending on the strength. Therefore, the study does not suggest that it’s safe for patients at risk for abnormal heart rhythm to consume unlimited amounts of caffeine. Rather, it suggests that moderate caffeine consumption may not be as dangerous as initially believed. 
 
I checked a report from my doctor, and yes, I do have left ventricular systolic dysfunction.  So it would appear that caffeine is okay for me to drink.  I am puzzled that 500 mg is the compared to a range of 2.5 to 5 cups of coffee rather than a set amount in ounces.  Does the number of cups depend on the size?  All I can say is that if I had five 8 ounce cups of coffee that would not be pretty.  I would probably be bouncing off the wall and continually running to the ladies room.  So I will stick with my daily cup of coffee which probably is somewhere around 8 to 10 ounces max.  I also think this is a good amount because coffee can have a dehydrating effect, and so I think one cup is manageable when I am limited to water intake in the neighborhood of 64 – 72 ounces.  So far with this amount I haven’t retained water.
 
I would also highlight an additional warning.  In my opinion, this study pertains only to drinking regular coffee, and not super caffeinated drinks.  In a previous post, I also talked about the danger to heart failure patients of caffeine loaded drinks that are currently popular on the market.  Just as a reminder, here is some information from the post about these drinks:  According to the Mayo Clinic, most energy drinks contain large amounts of caffeine, which can provide a temporary energy boost. But the boost is short-lived.   The caffeine or caffeine-like substances in the drinks may lead to a number of problems, one of which is rapid heartbeat. 

The Mayo Clinic also said that for most people, occasional energy drinks are fine, but try to limit yourself to about 16 ounces (500 milliliters) a day.  It is bad enough to have a slow heartbeat that has to be paced.  I don’t even want to imagine, or have to manage, rapid heartbeats.  So you can make your own decisions, but I am keeping away from energy drinks. 

​Just sign me up for one small (8 ounce) cup of plain coffee each day, and I will be a happy camper.  Again, it’s just a matter of balance, and I can manage my balance and the constant barrage of daily “breaking” news a bit better with I have some caffeine in my system.