This comprehensive review examines the cardiometabolic effects of coffee consumption, exploring biological mechanisms, clinical implications, and policy considerations. The review highlights that while coffee can cause short-term increases in blood pressure, it does not contribute to long-term hypertension risk. Coffee intake may reduce the risk of metabolic syndrome and non-alcoholic fatty liver disease, and is consistently linked to reduced risks of type 2 diabetes (T2D) and chronic kidney disease (CKD), showing dose-response relationships. Coffee consumption is also associated with a reduced risk of heart failure and all-cause mortality, following a U-shaped pattern, with the largest risk reduction observed at moderate consumption (1-5 cups/day). The relationship between coffee and cardiovascular disease is complex, showing potential stroke prevention benefits but ambiguous effects on coronary heart disease. The review also discusses the potential of coffee to contribute to extending healthspan and improving longevity, based on its beneficial effects on cardiometabolic health and aging processes. Mendelian randomization studies do not robustly support a causal link between coffee consumption and adverse cardiometabolic outcomes, but the findings underscore the need for further research to understand underlying mechanisms and refine health recommendations.This comprehensive review examines the cardiometabolic effects of coffee consumption, exploring biological mechanisms, clinical implications, and policy considerations. The review highlights that while coffee can cause short-term increases in blood pressure, it does not contribute to long-term hypertension risk. Coffee intake may reduce the risk of metabolic syndrome and non-alcoholic fatty liver disease, and is consistently linked to reduced risks of type 2 diabetes (T2D) and chronic kidney disease (CKD), showing dose-response relationships. Coffee consumption is also associated with a reduced risk of heart failure and all-cause mortality, following a U-shaped pattern, with the largest risk reduction observed at moderate consumption (1-5 cups/day). The relationship between coffee and cardiovascular disease is complex, showing potential stroke prevention benefits but ambiguous effects on coronary heart disease. The review also discusses the potential of coffee to contribute to extending healthspan and improving longevity, based on its beneficial effects on cardiometabolic health and aging processes. Mendelian randomization studies do not robustly support a causal link between coffee consumption and adverse cardiometabolic outcomes, but the findings underscore the need for further research to understand underlying mechanisms and refine health recommendations.