Caffeine and Cardiometabolic Health: Evidence, Controversies, and Clinical Considerations

Caffeine is the most widely consumed psychoactive substance globally, making its cardiometabolic effects particularly relevant, especially in individuals with established cardiovascular disease. This narrative review presents an overview of the current literature on caffeine and its impact on cardiometabolic risk factors by encompassing not only clinical but also mechanistic studies, eventually providing practical hints for clinical practice. A structured literature search was conducted via MEDLINE on caffeine and coffee in relation to cardiovascular health and disease. In patients with hypertension, caffeine intake is generally considered safe within certain limits, though individual factors, such as advanced age and CYP1A2 gene variants, may increase sensitivity. Caffeine's effects on the lipid profile vary by preparation method, with filtered coffee being more favorable than unfiltered forms. Although caffeine can acutely impair glycemic control in patients with diabetes, long-term intake may reduce complications like metabolic dysfunction-associated steatohepatitis, though it may also worsen diabetic renal disease. Caffeine consumed before exercise may impair coronary vasodilation in patients with coronary artery disease and should be avoided in this setting. Although moderate intake is safe for most adults, excessive caffeine consumption, especially from energy drinks containing additional stimulants, can pose severe cardiovascular risks for vulnerable individuals, such as those with arrhythmias, hypertension, or genetic susceptibilities. Despite its widespread use, few health authorities and scientific societies offer detailed guidance on caffeine consumption. Significant heterogeneity in study design, dosage, and patient selection limits the ability to translate findings into clinical recommendations. A more personalized approach, incorporating genetic variability and standardized dosing, may help optimize both safety and potential therapeutic benefits.