. 2006). Thisinverse association was stronger in women; those con-suming at least five cups a day were 31% less likely todie from cardiovascular disease than those drinking onecup or less.A meta-analysis based on ten prospective cohort stud-ies and seven case–control studies, concluded that anincrease in daily black tea consumption of three cupsdecreased the risk of myocardial infarction by 11% [rel-ative risk 0.89, 95% confidence interval (CI) 0.79–1.01], although there was evidence of publication biasand geographical differences with benefits seen prima-rily in studies in continental Europe (Peters et al. 2001).In contrast, an inverse association between tea drinkingand heart disease has not been demonstrated by UKstudies. In fact, Woodward and Tunstall-Pedoe (1999)found a modest positive relationship between tea con-sumption and all-cause mortality, including coronaryheart disease in the Scottish Heart Study. However, thisstudy failed to control for important confounders asso-ciated with tea consumption and a recent review ofthe evidence has supported the benefits of regular teaconsumption for coronary heart disease prevention(Gardner et al. 2007).Some studies have also suggested that tea consump-tion may be associated with lower mortality amongindividuals with established cardiovascular disease. Forexample, Mukamal et al. (2002) followed 1900 patientswho had suffered a myocardial infarction for 3.8 yearsand reported lower all-cause mortality and cardiovascu-lar mortality among the moderate (<14 cups/week) andheavy tea drinkers (14 or more cups/week) comparedwith non-drinkers after controlling for a number of clin-ical and sociodemographic characteristics (hazard ratiofor all-cause mortality among moderate drinkers was0.72, 95% CI 0.55–0.94 and for heavy drinkers was0.56, 95% CI 0.37–0.84).In vitro and in vivo studies have suggested that thisreduced risk may be due to the antioxidant, anti-inflam-matory, antithrombogenic and vasodilating effects oftea polyphenols. Tea is rich in the polyphenolic com-pounds flavonoids, including catechins (particularly epi-gallocatechin-3-gallate), flavonols, theaflavins andthearubigins. Green tea leaves contain more catechinsowing to their high epigallocatechin-3-gallate content,while black tea leaves, which undergo oxidation duringmanufacturing, contain more complex thearubigins andtheaflavins (British Nutrition Foundation 2003). Tea fla-vonoids are released when boiling water is added andare known to be rapidly absorbed into the circulationfollowing oral ingestion. Human intervention trials sug-gest that tea consumption (up to six cups per day)impacts significantly on plasma antioxidant capacity(Rietveld & Wiseman 2003), although methodologicaldifferences, for example in assay methods, make studiesdifficult to compare. There is also evidence that thisantioxidant capacity of tea flavonoids may improveendothelial function, a sensitive parameter of vascularwall homeostasis, although the response varies betweenindividuals (Hodgson et al. 2006).Flavonoids are found in other foods and beverages,such as cocoa, fruits and vegetables and red wine, buttea is an important dietary source. In the UK, one studyestimated tea to account for 82% of total flavonoidintake (Hertog et al. 1997). Although no long-term ran-
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