Tea does not appear harmful to health.  There is no clear cut advantage to green tea or coffee or black tea.  Coffee contains more caffeine, while tea contains more theophylline as their addictive ingredient.  While some studies do show advantages to drinking one or more of these, other studies have not found any benefit.

Tea Associated with Less Heart Disease in Saudi Arabia: In a study of total of 3,430 Saudi adults ages 30-70, those who did drink more than 6 cups of black tea (>480 mL) per day had a significantly lower prevalence of coronary heart disease (CHD) than the nontea drinkers (P < 0.001). Adjustments for risk factors including age, gender, occupation, education, smoking, family history, blood lipids, diabetes, blood pressure, BMI, physical activity, and coffee and fat intake did not remove the significance (OR = 0.49). There was a positive dose-response effect between tea consumption and CHD (P < 0.001) that was persistent after adjustment for various risk factors (P = 0.022). Tea consumption and the prevalence of coronary heart disease in Saudi adults: results from a Saudi national study. Hakim IA, Alsaif MA, Alduwaihy M, Al-Rubeaan K, Al-Nuaim AR, Al-Attas OS. King Saud University, Riyadh, Saudi Arabia. Prev Med. 2003 Jan;36(1):64-70 

Tea Associated with Fewer Heart Attacks: In a 5.6 year follow-up of 4807 adults over age 54 with no history of myocardial infarction, the relative risk (RR) of heart attacks was lower in tea drinkers with a daily intake >375 mL (RR: 0.57) than in nontea drinkers. The inverse association with tea drinking was even stronger for fatal events (0.30). The intake of dietary flavonoids (quercetin + kaempferol + myricetin) was significantly inversely associated only with fatal myocardial infarction (0.35) in upper compared with lower tertiles of intake. Inverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study. Geleijnse JM, Launer LJ, Van der Kuip DA, Hofman A, Witteman JC, Netherlands. Am J Clin Nutr. 2002 May;75(5):880-6

Tea Drinkers Less Likely Die After Heart Attack: In a prospective cohort study of 1900 patients hospitalized with a confirmed acute myocardial infarction between 1989 and 1994 with a median follow-up of 3.8 years, long-term mortality according to tea consumption was calculated. Of the 1,900 patients, 1,019 consumed no tea (nondrinkers), 615 consumed <14 cups per week (moderate tea drinkers) age- and sex-adjusted mortality RR 0.69, and 266 consumed 14 or more RR 0.61. Harvard. Tea consumption and mortality after acute myocardial infarction. Mukamal KJ, Maclure M, Muller JE, Sherwood JB, Mittleman MA. Circulation 2002 May 28;105(21):2476-81

Tea Good in Rotterdam: 4,807 adults over age 54 with no history of myocardial infarction with adjustment for age, sex, body mass index, smoking status, pack-years of cigarette smoking, education level, and daily intakes of alcohol, coffee, polyunsaturated fat, saturated fat, fiber, vitamin E, and total energy. During 5.6 y of follow-up, a total of 146 first myocardial infarctions occurred, 30 of which were fatal. The relative risk (RR) of incident myocardial infarction was lower in tea drinkers with a daily intake >375 mL (RR: 0.57) than in nontea drinkers. The inverse association with tea drinking was stronger for fatal events (0.30). The intake of dietary flavonoids (quercetin + kaempferol + myricetin) was significantly inversely associated only with fatal myocardial infarction (0.35; 0.13, 0.98) in upper compared with lower tertiles of intake. Inverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study. Geleijnse JM, Launer LJ, Van der Kuip DA, Hofman A, Witteman JC. Am J Clin Nutr 2002 May;75(5):880-6

Tea Helps: Black tea used in the Netherlands was found to decrease cardiac plaque linked to fatal heart attacks. Four cups or more per day cut severe atherosclerosis by more than two-third with two cups per cut it by half. Arch Int Med 10/11/99. 3500 in Rotterdam study in mid 60s. Effect strongest in women. Tea rich in antioxidants.

Tea, Apples, ?Chocolate Good in Zutphen Men: Zutphen Elderly Study, a prospective cohort study of 806 men aged 65-84 y. The mean (+/-SD) catechin intake at baseline was 72 +/- 47.8 mg, mainly from black tea, apples, and chocolate. A total of 90 deaths from ischemic heart disease were documented. Catechin intake was inversely associated with ischemic heart disease mortality; the multivariate-adjusted risk ratio in the highest tertile of intake was 0.49. After multivariate adjustment, catechin intake was not associated with the incidence of myocardial infarction (risk ratio in the highest tertile of intake: 0.70; 95% CI: 0.39, 1.26; P for trend: 0.232). After adjustment for tea consumption and flavonol intake, a 7.5-mg increase in catechin intake from sources other than tea was associated with a tendency for a 20% reduction in ischemic heart disease mortality risk (P = 0.114). There was no association between catechin intake and stroke incidence or mortality. Catechins, whether from tea or other sources, may reduce the risk of ischemic heart disease mortality

Apples, Wine, Not Tea Helps Iowa Postmenopausals: 767 of 34,492 participants initially free of cardiovascular diseases died from coronary heart disease. Strong inverse association between the intake of (+)-catechin and (-)-epicatechin and coronary heart disease death, which was somewhat attenuated after multivariate adjustment (risk ratios from lowest to highest quintile: 1.00, 0.95, 0.97, 0.77, 0.76). This inverse association was most pronounced in women at low risk of coronary heart disease (non-smokers, free of diabetes mellitus and cardiovascular diseases). A high intake of "gallates," catechins typical of tea, was not associated with coronary heart disease death. Of the major catechin sources, apples and wine were inversely associated with coronary heart disease death.

No Benefit Flavonoids in Male Health Professionals: 38,000 f/u 6y. relative risk for nonfatal myocardial infarction was 1.08 (95% Cl, 0.81 to 1.43) for the highest (median, 40.0 mg/d) compared with the lowest (median, 7.1 mg/d) quintiles for intake of flavonols and flavones after adjustment for age, obesity, smoking, intake of vitamin E, intake of alcohol, diabetes, hypertension, hypercholesterolemia, and family history of coronary heart disease. Harvard. Relation between intake of flavonoids and risk for coronary heart disease in male health professionals. Rimm EB, Katan MB, Ascherio A, Stampfer MJ, Willett WC. Ann Intern Med 1996 Sep 1;125(5):384-9

Kaiser Study No Mortality Effect by Coffee or Tea: 128,934 persons to 4,501 subsequent deaths. Except for slightly increased risk from acute myocardial infarction among heavier (> or = 4 cups/d) coffee users (relative risk versus nondrinkers = 1.4, 95% confidence interval = 1.0 to 1.9, P = 0.07), there was no increased risk of mortality for all deaths (relative risk per cup of coffee per day = 0.99, 95% confidence interval = 0.97 to 1.01; relative risk per cup of tea per day = 0.98, 95% confidence interval = 0.96 to 1.00) or major causes in adjusted analyses. Coffee was related to lower risk of liver cirrhosis death (relative risk per cup of coffee per day = 0.77, 95% confidence interval = 0.67 to 0.89). Use of both beverages was related to a lower risk of suicide, progressively lower at higher coffee intake (relative risk per cup of coffee per day = 0.87, 95% confidence interval = 0.77 to 0.98). We conclude that coffee and tea have no overall relation to mortality risk. Coffee, tea, and mortality. Klatsky AL, Armstrong MA, Friedman GD. Ann Epidemiol 1993 Jul;3(4):375-81

Benefits of Tea Unclear: The association between flavonol intake and cancer risk was investigated in three prospective studies (Zutphen Elderly Study in the Netherlands, a Finnish cohort, and the Netherlands Cohort Study). Only one study (Finnish cohort) showed an inverse association with cancer mortality. The intake of flavonols with subsequent cardiovascular disease was studied in six prospective epidemiological studies. In some populations (Seven Countries Study, Zutphen Elderly Study, a Finnish cohort) a clear protective effect was observed. In a large US cohort, a protective effect was only found in a subgroup with previous history of coronary heart disease, whereas in Welsh men, flavonol intake, mainly from tea, was associated with an increased risk of coronary heart disease. Tea flavonols in cardiovascular disease and cancer epidemiology. Hollman PC, Feskens EJ, Katan MB. Proc Soc Exp Biol Med 1999 Apr;220(4):198-202

Thomas E. Radecki, M.D., J.D.

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