American Journal of Clinical Nutrition, Vol 65, 1489-1494, Copyright © 1997 by The American Society for Clinical Nutrition, Inc

ORIGINAL RESEARCH COMMUNICATIONS

Antioxidant flavonols and ischemic heart disease in a Welsh population of men: the Caerphilly Study

MG Hertog, PM Sweetnam, AM Fehily, PC Elwood and D Kromhout
Department of Chronic Diseases and Environmental Epidemiology, National Institute of Public Health and the Environment, Bilthoven, Netherlands. Michael.Hertog@rium.ml

Antioxidant flavonols and their major food source, black tea, have been associated with a lower risk of ischemic heart disease (IHD) and stroke in Dutch men. We investigated whether flavonol intake predicted a lower rate of IHD in 1900 Welsh men aged 45-59 y, who were followed up for 14 y. Flavonol intake, mainly from tea to which milk is customarily added, was not related to IHD incidence [relative risk (RR), highest compared with lowest quartile: 1.0; 95% CI: 0.6, 1.6; P for trend = 0.996; n = 186] but was weakly positively related to IHD mortality (RR: 1.6; 95% CI: 0.9, 2.9; P = 0.119; n = 131) and cancer mortality (RR: 1.3; 95% CI: 0.7, 2.3; P = 0.150; n = 104) and strongly related to total mortality (RR: 1.4; 95% CI: 1.0, 2.0; P = 0.014; n = 334). Men with the highest consumption of tea (> 1.2 L, or > 8 cups/d) had an RR of 2.4 (95% CI: 1.5, 3.9) of dying in the follow-up period compared with men consuming < 300 mL/d (< 2 cups/d). We conclude that intake of antioxidant flavonols is not inversely associated with IHD risk in the United Kingdom. Possibly, flavonols from tea to which milk is added are not absorbed; experimental evidence suggests that adding milk to tea abolishes the plasma antioxidant-raising capacity of tea. The apparent association between tea consumption and increased mortality in this population merits further investigation.

This article has been cited by other articles:

				D. Grassi, A. Aggio, L. Onori, G. Croce, S. Tiberti, C. Ferri, L. Ferri, and G. Desideri Tea, Flavonoids, and Nitric Oxide-Mediated Vascular Reactivity J. Nutr., August 1, 2008; 138(8): 1554S - 1560S. [Abstract] [Full Text] [PDF]

				T. A. Barringer, L. Hatcher, and H. C. Sasser Potential Benefits on Impairment of Endothelial Function after a High-fat Meal of 4 weeks of Flavonoid Supplementation Evid. Based Complement. Altern. Med., July 3, 2008; (2008) nen048v1. [Abstract] [Full Text] [PDF]

				L. Hooper, P. A Kroon, E. B Rimm, J. S Cohn, I. Harvey, K. A Le Cornu, J. J Ryder, W. L Hall, and A. Cassidy Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials Am. J. Clinical Nutrition, July 1, 2008; 88(1): 38 - 50. [Abstract] [Full Text] [PDF]

				S. Debette, D. Courbon, N. Leone, J. Gariepy, C. Tzourio, J.-F. Dartigues, P. Barberger-Gateau, K. Ritchie, A. Alperovitch, P. Amouyel, et al. Tea Consumption Is Inversely Associated With Carotid Plaques in Women Arterioscler. Thromb. Vasc. Biol., February 1, 2008; 28(2): 353 - 359. [Abstract] [Full Text] [PDF]

				S. M. Shenouda and J. A. Vita Effects of Flavonoid-Containing Beverages and EGCG on Endothelial Function J. Am. Coll. Nutr., August 1, 2007; 26(4): 366S - 372S. [Abstract] [Full Text] [PDF]

				E. von Elm and G. Antes Tea without milk: lifestyle advice based on a small lab study Eur. Heart J., June 1, 2007; 28(11): 1398 - 1398. [Full Text] [PDF]

				J. Lin, K. M. Rexrode, F. Hu, C. M. Albert, C. U. Chae, E. B. Rimm, M. J. Stampfer, and J. E. Manson Dietary Intakes of Flavonols and Flavones and Coronary Heart Disease in US Women Am. J. Epidemiol., June 1, 2007; 165(11): 1305 - 1313. [Abstract] [Full Text] [PDF]

				O. K. Chun, S. J. Chung, and W. O. Song Estimated Dietary Flavonoid Intake and Major Food Sources of U.S. Adults J. Nutr., May 1, 2007; 137(5): 1244 - 1252. [Abstract] [Full Text] [PDF]

				E. Theodoratou, J. Kyle, R. Cetnarskyj, S. M. Farrington, A. Tenesa, R. Barnetson, M. Porteous, M. Dunlop, and H. Campbell Dietary Flavonoids and the Risk of Colorectal Cancer Cancer Epidemiol. Biomarkers Prev., April 1, 2007; 16(4): 684 - 693. [Abstract] [Full Text] [PDF]

				M. E. Widlansky, N. M. Hamburg, E. Anter, M. Holbrook, D. F. Kahn, J. G. Elliott, J. F. Keaney Jr., and J. A. Vita Acute EGCG Supplementation Reverses Endothelial Dysfunction in Patients with Coronary Artery Disease J. Am. Coll. Nutr., April 1, 2007; 26(2): 95 - 102. [Abstract] [Full Text] [PDF]

				P. J Mink, C. G Scrafford, L. M Barraj, L. Harnack, C.-P. Hong, J. A Nettleton, and D. R Jacobs Jr Flavonoid intake and cardiovascular disease mortality: a prospective study in postmenopausal women Am. J. Clinical Nutrition, March 1, 2007; 85(3): 895 - 909. [Abstract] [Full Text] [PDF]

				J. W. Erdman Jr., D. Balentine, L. Arab, G. Beecher, J. T. Dwyer, J. Folts, J. Harnly, P. Hollman, C. L. Keen, G. Mazza, et al. Flavonoids and Heart Health: Proceedings of the ILSI North America Flavonoids Workshop, May 31-June 1, 2005, Washington, DC J. Nutr., March 1, 2007; 137(3): 718S - 737S. [Abstract] [Full Text] [PDF]

				M. Lorenz, N. Jochmann, A. von Krosigk, P. Martus, G. Baumann, K. Stangl, and V. Stangl Addition of milk prevents vascular protective effects of tea Eur. Heart J., January 9, 2007; (2007) ehl442v1. [Abstract] [Full Text] [PDF]

				P. Pignatelli, S. Di Santo, B. Buchetti, V. Sanguigni, A. Brunelli, and F. Violi Polyphenols enhance platelet nitric oxide by inhibiting protein kinase C-dependent NADPH oxidase activation: effect on platelet recruitment FASEB J, June 1, 2006; 20(8): 1082 - 1089. [Abstract] [Full Text] [PDF]

				C. Vlachopoulos, N. Alexopoulos, I. Dima, K. Aznaouridis, I. Andreadou, and C. Stefanadis Acute Effect of Black and Green Tea on Aortic Stiffness and Wave Reflections J. Am. Coll. Nutr., June 1, 2006; 25(3): 216 - 223. [Abstract] [Full Text] [PDF]

				C. Cabrera, R. Artacho, and R. Gimenez Beneficial effects of green tea--a review. J. Am. Coll. Nutr., April 1, 2006; 25(2): 79 - 99. [Abstract] [Full Text] [PDF]

				J. A Vita Polyphenols and cardiovascular disease: effects on endothelial and platelet function Am. J. Clinical Nutrition, January 1, 2005; 81(1): 292S - 297S. [Abstract] [Full Text] [PDF]

				I. C. Arts and P. C. Hollman Polyphenols and disease risk in epidemiologic studies Am. J. Clinical Nutrition, January 1, 2005; 81(1): 317S - 325S. [Abstract] [Full Text] [PDF]

				Y.-C. Yang, F.-H. Lu, J.-S. Wu, C.-H. Wu, and C.-J. Chang The Protective Effect of Habitual Tea Consumption on Hypertension Arch Intern Med, July 26, 2004; 164(14): 1534 - 1540. [Abstract] [Full Text] [PDF]

				J. A. Vita Tea Consumption and Cardiovascular Disease: Effects on Endothelial Function J. Nutr., October 1, 2003; 133(10): 3293S - 3297. [Abstract] [Full Text] [PDF]

				M. J. Davies, J. T. Judd, D. J. Baer, B. A. Clevidence, D. R. Paul, A. J. Edwards, S. A. Wiseman, R. A. Muesing, and S. C. Chen Black Tea Consumption Reduces Total and LDL Cholesterol in Mildly Hypercholesterolemic Adults J. Nutr., October 1, 2003; 133(10): 3298S - 3302. [Abstract] [Full Text] [PDF]

				R. Cermak, S. Landgraf, and S. Wolffram The Bioavailability of Quercetin in Pigs Depends on the Glycoside Moiety and on Dietary Factors J. Nutr., September 1, 2003; 133(9): 2802 - 2807. [Abstract] [Full Text] [PDF]

				H. D Sesso, R. S Paffenbarger Jr, Y. Oguma, and I-M. Lee Lack of association between tea and cardiovascular disease in college alumni Int. J. Epidemiol., August 1, 2003; 32(4): 527 - 533. [Abstract] [Full Text] [PDF]

				H. D Sesso, J M. Gaziano, S. Liu, and J. E Buring Flavonoid intake and the risk of cardiovascular disease in women Am. J. Clinical Nutrition, June 1, 2003; 77(6): 1400 - 1408. [Abstract] [Full Text] [PDF]

				F. B. Hu and W. C. Willett Optimal Diets for Prevention of Coronary Heart Disease JAMA, November 27, 2002; 288(20): 2569 - 2578. [Abstract] [Full Text] [PDF]

				P. Knekt, J. Kumpulainen, R. Jarvinen, H. Rissanen, M. Heliovaara, A. Reunanen, T. Hakulinen, and A. Aromaa Flavonoid intake and risk of chronic diseases Am. J. Clinical Nutrition, September 1, 2002; 76(3): 560 - 568. [Abstract] [Full Text] [PDF]

				K. J. Mukamal, M. Maclure, J. E. Muller, J. B. Sherwood, and M. A. Mittleman Tea Consumption and Mortality After Acute Myocardial Infarction Circulation, May 28, 2002; 105(21): 2476 - 2481. [Abstract] [Full Text] [PDF]

				J. M Geleijnse, L. J Launer, D. A. van der Kuip, A. Hofman, and J. C. Witteman Inverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study Am. J. Clinical Nutrition, May 1, 2002; 75(5): 880 - 886. [Abstract] [Full Text] [PDF]

				S. Wolffram, M. Block, and P. Ader Quercetin-3-Glucoside Is Transported by the Glucose Carrier SGLT1 across the Brush Border Membrane of Rat Small Intestine J. Nutr., April 1, 2002; 132(4): 630 - 635. [Abstract] [Full Text] [PDF]

				D. L. McKay and J. B. Blumberg The Role of Tea in Human Health: An Update J. Am. Coll. Nutr., February 1, 2002; 21(1): 1 - 13. [Abstract] [Full Text] [PDF]

				S. E. LIPSHULTZ, S. D. FISHER, W. W. LAI, and T. L. MILLER Cardiovascular Monitoring and Therapy for HIV-Infected Patients Ann. N.Y. Acad. Sci., November 1, 2001; 946(1): 236 - 273. [Abstract] [Full Text] [PDF]

				U. Peters, C. Poole, and L. Arab Does Tea Affect Cardiovascular Disease? A Meta-Analysis Am. J. Epidemiol., September 15, 2001; 154(6): 495 - 503. [Abstract] [Full Text] [PDF]

				I. Erlund, G. Alfthan, J. Maenpaa, and A. Aro Tea and Coronary Heart Disease: the Flavonoid Quercetin Is More Bioavailable From Rutin in Women Than in Men Arch Intern Med, August 13, 2001; 161(15): 1919 - 1920. [Full Text] [PDF]

				I. C. Arts, P. C. Hollman, E. J. Feskens, H B. Bueno de Mesquita, and D. Kromhout Catechin intake might explain the inverse relation between tea consumption and ischemic heart disease: the Zutphen Elderly Study Am. J. Clinical Nutrition, August 1, 2001; 74(2): 227 - 232. [Abstract] [Full Text] [PDF]

				S. J. Duffy, J. F. Keaney Jr, M. Holbrook, N. Gokce, P. L. Swerdloff, B. Frei, and J. A. Vita Short- and Long-Term Black Tea Consumption Reverses Endothelial Dysfunction in Patients With Coronary Artery Disease Circulation, July 10, 2001; 104(2): 151 - 156. [Abstract] [Full Text] [PDF]

				S. J. Duffy, J. A. Vita, M. Holbrook, P. L. Swerdloff, and J. F. Keaney Jr Effect of Acute and Chronic Tea Consumption on Platelet Aggregation in Patients With Coronary Artery Disease Arterioscler. Thromb. Vasc. Biol., June 1, 2001; 21(6): 1084 - 1089. [Abstract] [Full Text] [PDF]

				B. A. Warden, L. S. Smith, G. R. Beecher, D. A. Balentine, and B. A. Clevidence Catechins Are Bioavailable in Men and Women Drinking Black Tea throughout the Day J. Nutr., June 1, 2001; 131(6): 1731 - 1737. [Abstract] [Full Text]

				R.A. Riemersma, C.A. Rice-Evans, R.M. Tyrrell, M.N. Clifford, and M.E.J. Lean Tea flavonoids and cardiovascular health QJM, May 1, 2001; 94(5): 277 - 282. [Abstract] [Full Text] [PDF]

				A. Roland, R. A. Patterson, and D. S. Leake Measurement of Copper-Binding Sites on Low Density Lipoprotein Arterioscler. Thromb. Vasc. Biol., April 1, 2001; 21(4): 594 - 602. [Abstract] [Full Text] [PDF]

				S. Samman, B. Sandstrom, M. B. Toft, K. Bukhave, M. Jensen, S. S Sorensen, and M. Hansen Green tea or rosemary extract added to foods reduces nonheme-iron absorption Am. J. Clinical Nutrition, March 1, 2001; 73(3): 607 - 612. [Abstract] [Full Text] [PDF]

				J. M. Geleijnse, L. J. Launer, A. Hofman, H. A. P. Pols, and J. C. M. Witteman Tea Flavonoids May Protect Against Atherosclerosis: The Rotterdam Study Arch Intern Med, October 11, 1999; 159(18): 2170 - 2174. [Abstract] [Full Text] [PDF]

				J. H. Stein, J. G. Keevil, D. A. Wiebe, S. Aeschlimann, and J. D. Folts Purple Grape Juice Improves Endothelial Function and Reduces the Susceptibility of LDL Cholesterol to Oxidation in Patients With Coronary Artery Disease Circulation, September 7, 1999; 100(10): 1050 - 1055. [Abstract] [Full Text] [PDF]

				J. F Young, S. E Nielsen, J. Haraldsdottir, B. Daneshvar, S. T Lauridsen, P. Knuthsen, A. Crozier, B. Sandstrom, and L. O Dragsted Effect of fruit juice intake on urinary quercetin excretion and biomarkers of antioxidative status Am. J. Clinical Nutrition, January 1, 1999; 69(1): 87 - 94. [Abstract] [Full Text] [PDF]