Menopause Live (29 November, 2010) From IMS

Coffee and tea are widely consumed beverages in the world and their relationship with health has therefore been extensively studied, particularly for cardiovascular disease (CVD). We recently reported a prospective cohort study of 37,514 Dutch men and women, in which we investigated the relationship of coffee and tea consumption with coronary heart disease (CHD) and stroke morbidity and mortality [1]. At baseline (1993–1997), coffee and tea consumption were estimated using a validated food frequency questionnaire and participants were then followed for occurrence of CVD through linkage with several registries. During the 13 years of follow-up, we identified 1881 incident cases of cardiovascular morbidity, of which 563 were caused by stroke and 1387 by CHD. In total, 1405 cases of all-cause mortality were documented, of which 70 were caused by stroke and 123 were caused by CHD. Coffee consumption was associated with CHD in a U-shaped manner, with the lowest hazard ratio (HR) of 0.79 for 2.1–3.0 cups/day (95% confidence interval (CI) 0.65–0.96, ptrend = 0.01). An inverse relationship of tea consumption with CHD was observed, with the lowest HR of 0.64 for > 6.0 cups/day (95% CI 0.46–0.90, ptrend = 0.02). Coffee and tea consumption were not associated with risk of stroke. Albeit not significant, coffee tended to be associated with a reduced risk of CHD mortality (HR 0.64; 95% CI: 0.37–1.11; ptrend = 0.12) for 3.1–6.0 cups/day. Tea consumption was associated with risk of CHD mortality in a U-shaped manner with a HR of 0.55 for 3.1–6.0 cups/day (95% CI 0.38–0.97, ptrend = 0.03). Coffee or tea consumption was not associated with stroke and all-cause mortality. In summary, high tea consumption was associated with a reduced risk of CHD mortality. Our study also suggests a modest risk reduction for CHD mortality with moderate coffee consumption and confirmed the lower risk of CHD with coffee and tea consumption [1].

Comment
A meta-analysis on coffee consumption and CVD showed that habitual coffee consumption of 3–4 cups per day was related to a decreased risk of coronary heart disease (CHD), with a relative risk of 0.87 [2]. Our results were almost similar with a HR of 0.79 for 2–3 cups per day and of 0.82 for 3–4 cups per day. The association of coffee drinking with stroke is not clear. The Nurses’ Health Study suggested a modestly reduced risk of stroke with coffee consumption [3], but our data could not confirm these results. This could be due to a smaller sample size compared to the Nurses’ Health Study. Finally, two recent studies suggested a modestly reduced risk of all-cause and cardiovascular mortality with moderate coffee consumption [4,5]. We did not observe significant associations between coffee consumption and all-cause or CVD mortality, but our results do confirm a modest risk reduction for CHD mortality. 

A meta-analysis on tea consumption and CVD concluded that results for CHD and stroke were inconsistent, but the study observed a protective effect in the European region for myocardial infarction [6]. Our results for tea consumption and CHD are well in line with this study. Studies on the relationship between tea consumption and all-cause or CVD mortality are scarce. A recent study on green tea observed an inverse association for CVD mortality [7]. A few studies on black tea were performed, but only in specific subpopulations or focused on components from tea like flavonoids [8-10]. The evidence from these studies is weak, but they do suggest an inverse association with CVD mortality. Our study shows that high tea consumption, mainly from black tea, is associated with a reduced risk of CHD. Both green and black tea thus seem to be related with a decreased risk of CHD mortality.

Joline W. J. Beulens and Yvonne T. van der Schouw
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

References
1. de Koning Gans JM, Uiterwaal CS, van der Schouw YT, et al. Tea and coffee consumption and cardiovascular morbidity and mortality. Arterioscler Thromb Vasc Biol 2010;30:1665-71.
http://www.ncbi.nlm.nih.gov/pubmed/20562351
2. Wu JN, Ho SC, Zhou C, et al. Coffee consumption and risk of coronary heart diseases: A meta-analysis of 21 prospective cohort studies. Int J Cardiol 2009;137:216-25.
http://www.ncbi.nlm.nih.gov/pubmed/18707777
3. Lopez-Garcia E, Rodriguez-Artalejo F, Rexrode KM, et al. Coffee consumption and risk of stroke in women. Circulation 2009;119:1116-23.
http://www.ncbi.nlm.nih.gov/pubmed/19221216
4. Andersen LF, Jacobs DR Jr, Carlsen MH, Blomhoff R. Consumption of coffee is associated with reduced risk of death attributed to inflammatory and cardiovascular diseases in the Iowa Women’s Health Study. Am J Clin Nutr 2006;83:1039-46.
http://www.ncbi.nlm.nih.gov/pubmed/16685044
5. Lopez-Garcia E, van Dam RM, Li TY, et al. The relationship of coffee consumption with mortality. Ann Intern Med 2008;148:904-14.
http://www.ncbi.nlm.nih.gov/pubmed/18559841
6. Peters U, Poole C, Arab L. Does tea affect cardiovascular disease? A meta-analysis. Am J Epidemiol 2001;154:495-503.
http://www.ncbi.nlm.nih.gov/pubmed/11549554
7. Kuriyama S, Shimazu T, Ohmori K, et al. Green tea consumption and mortality due to cardiovascular disease, cancer, and all causes in Japan: the Ohsaki study. JAMA 2006;296:1255-65.
http://www.ncbi.nlm.nih.gov/pubmed/16968850
8. Arts IC, Jacobs DR Jr, Harnack LJ, et al. Dietary catechins in relation to coronary heart disease death among postmenopausal women. Epidemiology 2001;12:668-75.
http://www.ncbi.nlm.nih.gov/pubmed/11679795
9. Geleijnse JM, Launer LJ, Van der Kuip DA, et al. Inverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study. Am J Clin Nutr 2002;75:880-6.
http://www.ncbi.nlm.nih.gov/pubmed/11976162
10. Hertog MG, Feskens EJ, Hollman PC, et al. Dietary antioxidant flavonoids and risk of coronary heart disease: the Zutphen Elderly Study. Lancet 1993;342:1007-11.
http://www.ncbi.nlm.nih.gov/pubmed/8105262