Coffee and Cholesterol: What Is the Link?

The link between coffee and cholesterol potentially involves several factors, including how the coffee is brewed, how much coffee is consumed, and how you metabolize coffee (your genetics).

Coffee is a central part of many people's daily rituals, and the question is whether the benefits of coffee outweigh the risks. And, if risks do exist, are there ways to reduce them if you have high cholesterol?

Preparation Method

When it comes to the benefits and risks of coffee, how you prepare a cup can make a big difference.

There are many different varieties of coffee, but they are fundamentally prepared in two ways: filtered and unfiltered.

• Filtered coffee is the most common method of preparation in the United States and involves brewing the coffee through a filter.
• Unfiltered coffee, also known as “boiled coffee," does not use a filter and includes espresso, Turkish coffees, and French press coffees.

Generally speaking, unfiltered coffee poses higher potential risks if you have hyperlipidemia (high blood lipids, including cholesterol). This is because two compounds, cafestol and kahweol, remain in unfiltered coffee and are likely responsible for increasing cholesterol.

Other studies include the following:

• A 2012 review evaluating 12 different studies with over 1,000 participants concluded that regular consumption of unfiltered coffee increases total cholesterol (TC) and harmful low-density lipoprotein (LDL) cholesterol.

According to the researchers, higher consumption of unfiltered coffee corresponded to higher TC and LDL levels. By contrast, drinking filtered coffee had no notable effect on either TC or LDL levels.

• A 2018 study evaluated how much coffee people 18 to 24 drank over one week and compared it to their cholesterol levels. The researchers found that the more espresso-based drinks the participants consumed, the higher their cholesterol.
• Other studies have suggested that smoking amplifies the risk of unfiltered coffee (in part because smoking causes narrowing of blood vessels). When combined, unfiltered coffee and smoking may increase LDL levels and decrease beneficial high-density lipoprotein (HDL) levels. This risk is highest in smokers who consume 3 or more cups per day.

As interesting as the findings are, they are not consistent. A small but relevant clinical trial could not find an association between regular consumption of unfiltered coffee—in this case, Turkish coffee—and elevated blood lipids. The same was true whether or not the coffee was consumed with cream or if the person was a smoker or non-smoker.

Realistic Effects

Based on the current body of research, there is no clear-cut answer as to whether coffee on its own is going to detrimentally influence cholesterol levels. As with all things related to cholesterol and heart disease, the causes are complex and involve a mix of diet, exercise, genetics, and lifestyle habits.

Research suggests that the daily consumption of 10 milligrams (mg) of cafestol—equal to around five cups of espresso—increases cholesterol by 2.34 mg/dL after four weeks. Although this is a significant increase, it may not necessarily push you into the abnormal range if your LDL is below 100 mg/dL (considered the normal range).

While there is a chance that coffee may increase your cholesterol levels, there is also evidence that daily coffee consumption may decrease your cardiovascular risk by up to 15%. Moreover, there is no evidence that coffee increases the risk of cardiovascular disease, even in those with a prior cardiovascular event.

If you have trouble controlling your cholesterol, talk with your healthcare provider. They may advise you to reduce your intake if you're a heavy coffee drinker but will more likely focus on interventions with proven benefits.

Amount of Coffee Consumed

A 2023 study found that over 4 cups of coffee daily may increase LDL levels for some people. But major cardiovascular diseases, including heart failure, were not linked to coffee consumption.

A 2022 study noted that people who drank 2 to 3 cups of coffee daily had a lower risk of heart problems than those who didn’t, and the risk of stroke or heart-linked death was the lowest for people who drank 1 cup of coffee each day.

A 2017 review of studies summarized recommended coffee consumption by suggesting that drinking no more than 3 to 4 cups per day is "more likely to benefit health than harm."

Coffee Metabolism

How you metabolize coffee and caffeine may also affect the benefits and risks of drinking coffee. Genetic variations in enzymes involved in caffeine metabolism may influence how individuals respond to caffeine and coffee. 

Older studies suggest that "slow" caffeine metabolizers may have a higher risk of heart problems with coffee consumption, while "fast" metabolizers may get a protective effect. 

A 2024 study determined that cafestol in coffee beans can affect how cholesterol metabolism occurs in the body. If you have a genetic mutation that slows down coffee metabolism in your body and you drink 2 or more cups of coffee per day, your risk for heart disease may be higher.

However, other studies have found that genetic variants don't show a significant effect on the association between coffee intake and CVD risk. 

Beneficial Ingredients in Coffee

A single cup of coffee contains a surprising number of bioactive ingredients that can directly influence a person's physical and mental health and well-being.

These include:

• Caffeine (which decreases fatigue and improves mental functioning)
• Essential minerals (like calcium, magnesium, phosphorus, and potassium)
• Polyphenols (that reduce blood sugar and relax arteries)
• Melanoidins (that aid in fat metabolism)
• Chlorogenic acid (a potent antioxidant)
• Diterpenes (said to have anti-inflammatory and antispasmodic properties)

What isn't known is how much cafestol or kahweol it takes to affect cholesterol levels (studies vary on this effect) or if other bioactive ingredients in coffee, such as polyphenols, potentially mitigate this risk.

It's also worth noting that cafestol and kahweol both have anti-inflammatory and anti-diabetes effects that are beneficial to one's health.

Other Added Ingredients

When visiting the typical coffee house, you are likely to be faced with an extensive menu of hot and cold coffee beverages, including lattes, cappuccinos, frappes, mochaccinos, cold brews, and a plethora of flavored coffees.

As much as you might worry about coffee's effect on your cholesterol, arguably the bigger concern is the other added ingredients in coffee drinks that add saturated fat and sugar. These ingredients may increase your risk of heart disease, obesity, and type 2 diabetes.

Consider, for example, that a 16-ounce Starbucks Cinnamon Dolce Creme Frappuccino delivers:

• 360 calories, of which 130 calories are from fat
• 55 grams of dietary cholesterol (18% of your recommended daily intake)
• 9 grams of saturated fat (45% of your recommended daily intake)
• 42 grams of sugar (more than 100% of the recommended daily intake)

Compare this to a 16-ounce serving of plain coffee, which has only 5 calories and no fat, cholesterol, sodium, or carbohydrates.

Other added ingredients that can add saturated fat and/or sugar include:

• Half-and-half
• Cream
• Flavored creamers
• Plant-based milks, like coconut and cashew milk
• Keto coffee, also called bulletproof coffee, made by adding butter and coconut oil to black coffee

Other Effects of Coffee

When we think about cholesterol, we generally think that "high" means "bad." And, while this is certainly true with LDL cholesterol, increased levels of HDL cholesterol are generally considered a good thing.

Triglycerides and HDL Cholesterol:

Among its benefits, HDL cholesterol absorbs excess cholesterol in the blood and carries it back to the liver, where it is flushed out of the body. Increases in HDL generally correspond to decreases in the risk of heart disease and stroke.

A 2020 study reported that while high consumption of unfiltered espresso did increase TC and LDL levels in both men and women, it also increased HDL and decreased triglyceride levels. Decreased triglycerides are linked to a lower risk of heart disease.

The same study also noted that regular consumption of tea and instant coffee had no detrimental effect on a person's blood lipid profile.

Blood Pressure:

Caffeine can trigger a short but dramatic increase in blood pressure, even for people who have normal blood pressure. Caffeine stimulates the release of calcium from the lining of the stomach which causes blood vessels to contract, increasing blood pressure.

Because the effect is temporary, it may not be harmful, but it certainly doesn't help if your blood pressure is not well controlled.

Risks of Drinking Coffee

Although there has been much published about the benefits of coffee, it is important to consider the possible risks, particularly if you are a heavy coffee drinker.

Among them:

• The high caffeine content can overstimulate the central nervous system, triggering anxiety, restlessness, headaches, insomnia, and heart palpitations. Poor sleep causes daytime sleepiness and reduced alertness and mental performance.
• Coffee is acidic and can promote stomach upset in some people, particularly those with chronic gastritis or irritable bowel syndrome (IBS). It can also speed up gastric emptying and can make diarrhea worse in people with IBS or inflammatory bowel disease (IBD).
• High consumption of coffee in females (8 or more cups per day) increases the risk of bone fractures by 150%. This effect is not seen in males.
• High consumption of coffee during pregnancy may also increase the risk of low birth weight, preterm birth, and pregnancy loss compared to low to moderate consumption.

Drug Interactions

The caffeine content in coffee may amplify the effects of certain drugs, especially stimulants. Taking coffee and stimulants together can increase both your heart rate and blood pressure, sometimes severely.

Examples of stimulants include:

• Appetite suppressants
• Epinephrine (adrenaline)
• Lomaira (phentermine)
• Provigil (modafinil)
• Sudafed (pseudoephedrine)
• Tenuate (diethylpropion)
• Recreational drugs like cocaine and methamphetamine

Caffeine and other organic compounds in coffee can also interfere with the absorption of some pharmaceutical drugs, making them less effective.

These include:

• Iron supplements
• Levothyroxine (T4)
• Phenothiazine drugs like chlorpromazine
• Versed (midazolam)

Coffee can increase the absorption of drugs like aspirin and levodopa, increasing the risk of side effects.

Summary

The potential link between coffee and cholesterol involves factors such as preparation method, the amount of coffee consumed, and your genetics. Moderate consumption of coffee is key to reaping the potential health benefits while lowering potential risks—including those related to high cholesterol.

If you have concerns about your cholesterol and coffee consumption and/or you experience edginess, insomnia, or other adverse effects when drinking coffee, talk to your healthcare provider.