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Tea consumption and risk of cardiovascular outcomes and total mortality: a systematic review and meta-analysis of prospective observational studies

European Journal of Epidemiology volume 30, pages 103–113 (2015)Cite this article

Abstract

Studies that investigated the association between tea consumption and the risk of major cardiovascular events have reported inconsistent results. We conducted a meta-analysis of prospective observational studies in order to summarize the evidence regarding the association between tea consumption and major cardiovascular outcomes or total mortality. In July 2014, we performed electronic searches in PubMed, EmBase, and the Cochrane Library, followed by manual searches of reference lists from the resulting articles to identify other relevant studies. Prospective observational studies that reported effect estimates, with 95 % confidence intervals (CIs), for coronary heart disease (CHD), stroke, cardiac death, stroke death, or total mortality for more than two dosages of tea consumption were included. A random-effects meta-analysis was performed to determine the risk of major cardiovascular outcomes associated with an increase in tea consumption by 3 cups per day. Of the 736 citations identified from database searches, we included 22 prospective studies from 24 articles reporting data on 856,206 individuals, and including 8,459 cases of CHD, 10,572 of stroke, 5,798 cardiac deaths, 2,350 stroke deaths, and 13,722 total deaths. Overall, an increase in tea consumption by 3 cups per day was associated with a reduced risk of CHD (relative risk [RR], 0.73; 95 % CI: 0.53–0.99; P = 0.045), cardiac death (RR, 0.74; 95 % CI: 0.63–0.86; P < 0.001), stroke (RR, 0.82; 95 % CI: 0.73–0.92; P = 0.001), total mortality (RR, 0.76; 95 % CI: 0.63–0.91; P = 0.003), cerebral infarction (RR, 0.84; 95 % CI: 0.72–0.98; P = 0.023), and intracerebral hemorrhage (RR, 0.79; 95 % CI: 0.72–0.87; P < 0.001), but had little or no effect on stroke mortality (RR, 0.93; 95 % CI: 0.83–1.05; P = 0.260). The findings from this meta-analysis indicate that increased tea consumption is associated with a reduced risk of CHD, cardiac death, stroke, cerebral infarction, and intracerebral hemorrhage, as well as total mortality.

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References

  1. Rimm ER, Katan MB, Ascherio A, Stampfer MJ, Willett WC. Relation between intake of flavonoids and risk for coronary heart disease in male health professionals. Ann Intern Med. 1996;125:384–9.

    Article  CAS  PubMed  Google Scholar 

  2. Sone T, Kuriyama S, Nakaya N, Hozawa A, Shimazu T, Nomura K, Rikimaru S, Tsuji I. Randomized controlled trial for an effect of catechin-enriched green tea consumption on adiponectin and cardiovascular disease risk factors. Food Nutr Res 2011;55. doi: 10.3402.

  3. Food and Agriculture Organization of the United Nations. Food balance sheets. 1996;1994–6.

  4. Mink PJ, Scrafford CG, Barraj LM, Harnack L, Hong CP, Nettleton JA, Jacobs DR Jr. Flavonoid intake and cardiovascular disease mortality: a prospective study in postmenopausal women. Am J Clin Nutr. 2007;85:895–909.

    CAS  PubMed  Google Scholar 

  5. Wang X, Ouyang YY, Liu J, Zhao G. Flavonoid intake and risk of CVD: a systematic review and meta-analysis of prospective cohort studies. Br J Nutr. 2014;111:1–11.

    Article  PubMed  Google Scholar 

  6. de Koning Gans JM, Uiterwaal CS, van der Schouw YT, Boer JM, Grobbee DE, Beulens JW, Verschuren WM. Tea and coffee consumption and cardiovascular morbidity and mortality. Arterioscler Thromb Vasc Biol. 2010;30:1665–71.

    Article  PubMed  Google Scholar 

  7. Suzuki E, Yorifuji T, Takao S, Komatsu H, Sugiyama M, Ohta T, Ishikawa-Takata K, Doi H. Green tea consumption and mortality among Japanese elderly people: the prospective Shizuoka elderly Cohort. Ann Epidemiol. 2009;19:732–9.

    Article  PubMed  Google Scholar 

  8. Mukamal KJ, Maclure M, Muller JE, Sherwood JB, Mittleman MA. Tea consumption and mortality after acute myocardial infarction. Circulation. 2002;105:2476–81.

    Article  PubMed  Google Scholar 

  9. Geleijnse JM, Launer LJ, Van der Kuip DA, Hofman A, Witteman JC. Inverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study. Am J Clin Nutr. 2002;75:880–6.

    CAS  PubMed  Google Scholar 

  10. Woodward M, Tunstall-Pedoe H. Coffee and tea consumption in the Scottish Heart Health Study follow up: conflicting relations with coronary risk factors, coronary disease, and all cause mortality. J Epidemiol Community Health. 1999;53:481–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Hertog MG, Sweetnam PM, Fehily AM, Elwood PC, Kromhout D. Antioxidant flavonols and ischemic heart disease in a Welsh population of men: the Caerphilly Study. Am J Clin Nutr. 1997;65:1489–94.

    CAS  PubMed  Google Scholar 

  12. Sato Y, Nakatsuka H, Watanabe T, Jousilahti P, Antikainen R, Tuomilehto J. Possible contribution of green tea drinking habits to the prevention of stroke. Tohoku J Exp Med. 1989;157:337–43.

    Article  CAS  PubMed  Google Scholar 

  13. Keli SO, Hertog MG, Feskens EJ, Kromhout D. Dietary flavonoids, antioxidant vitamins, and incidence of stroke: the Zutphen study. Arch Intern Med. 1996;154:637–42.

    Article  Google Scholar 

  14. Hertog MG, Feskens EJ, Hollman PC, Katan MB, Kromhout D. Dietary antioxidant flavonoids and risk of coronary heart disease: the Zutphen Elderly Study. Lancet. 1993;342:1007–11.

    Article  CAS  PubMed  Google Scholar 

  15. Arab L, Liu W, Elashoff D. Green and Black Tea Consumption and Risk of Stroke: a meta-analysis. Stroke. 2009;40:1786–92.

    Article  CAS  PubMed  Google Scholar 

  16. Peters U, Poole C, Arab L. Does tea affect cardiovascular disease? A meta-analysis. Am J Epidemiol. 2001;154:495–503.

    Article  CAS  PubMed  Google Scholar 

  17. Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA group. Preferred Reporting Items for systematic reviews and meta-analyses: the PRISMA statement. Plos Med. 2009;6:e1000097.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Wells G, Shea B, O’Connell D. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa (ON): Ottawa Hospital Research Institute. 2009. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.

  19. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions, version 5.1.0.2011. www.cochrane-handbook.org.

  20. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  CAS  PubMed  Google Scholar 

  21. Ades AE, Lu G, Higgins JP. The interpretation of random-effects metaanalysis in decision models. Med Decis Mak. 2005;25:646–54.

    Article  CAS  Google Scholar 

  22. Orsini N, Bellocco R, Greenland S. Generalized least squares for trend estimation of summarized dose–response data. Stata J. 2006;6:40–57.

    Google Scholar 

  23. Greenland S, Longnecker MP. Methods for trend estimation from summarized dose–response data, with applications to meta-analysis. Am J Epidemiol. 1992;135:1301–9.

    CAS  PubMed  Google Scholar 

  24. Deeks JJ, Higgins JPT, Altman DG. Analyzing data and undertaking meta-analyses. In: Higgins J, Green S, editors. Cochrane handbook for systematic reviews of interventions 5.0.1. Oxford: The Cochrane Collaboration; 2008. chap 9:9.5.4.

  25. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.

    Article  PubMed  Google Scholar 

  27. Tobias A. Assessing the influence of a single study in meta-analysis. Stata Tech Bull. 1999;47:15–7.

    Google Scholar 

  28. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.

    Article  CAS  PubMed  Google Scholar 

  30. Kokubo Y, Iso H, Saito I, Yamagishi K, Yatsuya H, Ishihara J, Inoue M, Tsugane S. The impact of green tea and coffee consumption on the reduced risk of stroke incidence in Japanese population: the Japan public health center-based study cohort. Stroke. 2013;44:1369–74.

    Article  CAS  PubMed  Google Scholar 

  31. Larsson SC, Virtamo J, Wolk A. Black tea consumption and risk of stroke in women and men. Ann Epidemiol. 2013;23:157–60.

    Article  PubMed  Google Scholar 

  32. Leurs LJ, Schouten LJ, Goldbohm RA, van den Brandt PA. Total fluid and specific beverage intake and mortality due to IHD and stroke in the Netherlands Cohort Study. Br J Nutr. 2010;104:1212–21.

    Article  CAS  PubMed  Google Scholar 

  33. Mineharu Y, Koizumi A, Wada Y, Iso H, Watanabe Y, Date C, Yamamoto A, Kikuchi S, Inaba Y, Toyoshima H, Kondo T, Tamakoshi A. JACC study group: coffee, green tea, black tea and oolong tea consumption and risk of mortality from cardiovascular disease in Japanese men and women. J Epidemiol Community Health. 2011;65:230–40.

    Article  PubMed  Google Scholar 

  34. Lopez-Garcia E, Rodriguez-Artalejo F, Rexrode KM, Logroscino G, Hu FB, van Dam RM. Coffee consumption and risk of stroke in women. Circulation. 2009;119:1116–23.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Tanabe N, Suzuki H, Aizawa Y, Seki N. Consumption of green and roasted teas and the risk of stroke incidence: results from the Tokamachi-Nakasato cohort study in Japan. Int J Epidemiol. 2008;37:1030–40.

    Article  PubMed  Google Scholar 

  36. Larsson SC, Männistö S, Virtanen MJ, Kontto J, Albanes D, Virtamo J. Coffee and tea consumption and risk of stroke subtypes in male smokers. Stroke. 2008;39:1681–7.

    Article  CAS  PubMed  Google Scholar 

  37. Kuriyama S, Shimazu T, Ohmori K, Kikuchi N, Nakaya N, Nishino Y, Tsubono Y, Tsuji I. Green tea consumption and mortality due to cardiovascular disease, cancer, and all causes in Japan: the Ohsaki Study. JAMA. 2006;296:1255–65.

    Article  CAS  PubMed  Google Scholar 

  38. Sesso HD, Paffenbarger RS Jr, Oguma Y, Lee IM. Lack of association between tea and cardiovascular disease in college alumni. Int J Epidemiol. 2003;32:527–33.

    Article  PubMed  Google Scholar 

  39. Klatsky A, Armsterong MA, Frienman G. Coffee, tea, and mortality. Ann Epidemiol. 1993;3:375–81.

    Article  CAS  PubMed  Google Scholar 

  40. Lopez-Garcia E, van Dam RM, Willett WC, Rimm EB, Manson JE, Stampfer MJ, Rexrode KM, Hu FB. Coffee consumption and coronary heart disease in men and women: a prospective cohort study. Circulation. 2006;113:2045–53.

    Article  PubMed  Google Scholar 

  41. Sesso HD, Gaziano JM, Liu S, Buring JE. Flavonoid intake and the risk of cardiovascular disease in women. Am J Clin Nutr. 2003;77:1400–8.

    CAS  PubMed  Google Scholar 

  42. Yochum L, Kushi LH, Meyer K, Folsom AR. Dietary flavonoid intake and risk of cardiovascular disease in postmenopausal women. Am J Epidemiol. 1999;149:943–9.

    Article  CAS  PubMed  Google Scholar 

  43. Bidel S, Hu G, Qiao Q, Jousilahti P, Antikainen R, Tuomilehto J. Coffee consumption and risk of total and cardiovascular mortality among patients with type 2 diabetes. Diabetologia. 2006;49:2618–26.

    Article  CAS  PubMed  Google Scholar 

  44. Duvall S, Tweedie R. A nonparametric ‘‘trim and fill’’ method for assessing publication bias in meta-analysis. J Am Stat Assoc. 2000;95:89–98.

    Google Scholar 

  45. Schlesselman JJ. Case-control studies. Design, conduct, analysis. New York: Oxford University Press; 1982.

    Google Scholar 

  46. de Whalley CV, Rankin SM, Hoult JR, Jessup W, Leake DS. Flavonoids inhibit the oxidative modification of low density lipoproteins by macrophages. Biochem Pharmacol. 1990;39:1743–50.

    Article  PubMed  Google Scholar 

  47. Basu A, Sanchez K, Leyva MJ, Wu M, Betts NM, Aston CE, Lyons TJ. Green tea supplementation affects body weight, lipids, and lipid peroxidation in obese subjects with metabolic syndrome. J Am Coll Nutr. 2010;29:31–40.

    Article  CAS  PubMed  Google Scholar 

  48. Salonen JT, Yla-Herttuala S, Yamamoto R, Butler S, Korpela H, Salonen R, Nyyssönen K, Palinski W, Witztum JL. Autoantibody against oxidised LDL and progression of carotid atherosclerosis. Lancet. 1992;339:883–7.

    Article  CAS  PubMed  Google Scholar 

  49. Bergmark C, Wu R, de Faire U, Lefvert AK, Swedenborg J. Patients with early-onset peripheral vascular disease have increased levels of autoantibodies against oxidized LDL. Arterioscler Thromb Vasc Biol. 1995;15:441–5.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was funded by The Ministry of Science and Technology of China (2008ZX10002-007, 2008ZX10002-018, 2008ZX10002-025), The Leading Talents of Science in Shanghai 2010 (022), The Key Discipline Construction of Evidence-Based Public Health in Shanghai (12GWZX0602), The National Science Foundation of China (81373105). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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None of the author has a conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Shanghai Seventh People’s Hospital, Shanghai, 200137, China

    Chi Zhang

  2. Department of Health Statistics, Second Military Medical University, Shanghai, 200433, China

    Ying-Yi Qin, Fei-Fei Yu & Jia He

  3. Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Xin Wei

  4. Department of Rehabilitation Institute, Shanghai Seventh People’s Hospital, Shanghai, 200137, China

    Yu-Hao Zhou

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  1. Chi Zhang
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Correspondence to Yu-Hao Zhou or Jia He.

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Chi Zhang, Ying-Yi Qin, Xin Wei and Fei-Fei Yu have contributed equally to this article.

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Zhang, C., Qin, YY., Wei, X. et al. Tea consumption and risk of cardiovascular outcomes and total mortality: a systematic review and meta-analysis of prospective observational studies. Eur J Epidemiol 30, 103–113 (2015). https://doi.org/10.1007/s10654-014-9960-x

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  • DOI: https://doi.org/10.1007/s10654-014-9960-x

Keywords

  • Tea
  • Cardiovascular disease
  • Total mortality
  • Dose–response
  • Meta-analysis