Green and Black Tea Consumption and Risk of Stroke: A Meta-Analysis
Abstract
Background and Purpose— Experimental models of stroke provide consistent evidence of smaller stroke volumes in animals ingesting tea components or tea extracts. To assess whether a similar association of black or green tea consumption with reduced risk is evident in human populations, we sought to identify and summarize all human clinical and observational data on tea and stroke. Methods— We searched PubMed and Web of Science for all studies on stroke and tea consumption in humans with original data, including estimation or measurement of tea consumption and outcomes of fatal or nonfatal stroke. Data from 9 studies involving 4378 strokes among 194 965 individuals were pooled. The main outcome was the occurrence of fatal or nonfatal stroke. We tested for heterogeneity and calculated the summary effect estimate associated with consumption of ≥3 cups of tea (green or black) per day using random-effects and fixed-effects models for the homogeneous studies. Publication bias was also evaluated. Results— Regardless of their country of origin, individuals consuming ≥3 cups of tea per day had a 21% lower risk of stroke than those consuming <1 cup per day (absolute risk reduction, 0.79; CI, 0.73 to 0.85). The proportion of heterogeneity not explained by chance alone was 23.8%. Conclusions— Although a randomized clinical trial would be necessary to confirm the effect, this meta-analysis suggests that daily consumption of either green or black tea equaling 3 cups per day could prevent the onset of ischemic stroke.
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One meta-analysis (Arab et al., 2009) of tea consumption and stroke risk found similar results.
“One meta-analysis (Arab et al., 2009) of prospective cohort studies which assessed the relationship between green and black tea consumption and the risk of stroke and included data from nine individual studies involving 4 378 strokes among 194 965 individuals in total found similar results.”
From Scientific Opinion on the safety of caffeine (2015) · cites this paper as Arab et al., 2009
Cites
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722 · see citing works
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552 · see citing works
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
Operating characteristics of a rank correlation test for publication bias
Begg, C. B., & Mazumdar, M. (1994) · Biometrics · doi:10.2307/2533446 · Cited by 16,955 · see citing works
Lopez, A. D., Mathers, C. D., Ezzati, M., Jamison, D. T., & Murray, C. J. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68770-9 · Cited by 5,630 · see citing works
Heart Disease and Stroke Statistics—2008 Update
Writing Group Members, Rosamond, W. D., Flegal, K. M., Furie, K. L., Go, A. S., Greenlund, K. J., Haase, N., Hailpern, S. M., Ho, M., Howard, V. J., et al. (2007) · Circulation · doi:10.1161/circulationaha.107.187998 · Cited by 3,745 · see citing works
Rosamond, W., Flegal, K., Friday, G., Furie, K., Go, A., Greenlund, K., Haase, N., Ho, M., Howard, V., Kissela, B., et al. (2007) · Circulation · doi:10.1161/circulationaha.106.179918 · Cited by 3,277 · see citing works
Methods for Trend Estimation from Summarized Dose-Response Data, with Applications to Meta-Analysis
Greenland, S., & Longnecker, M. P. (1992) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116237 · Cited by 2,353 · see citing works
Hooper, L., Kroon, P. A., Rimm, E. B., Cohn, J. S., Harvey, I., Le Cornu, K. A., Ryder, J. J., Hall, W. L., & Cassidy, A. (2008) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/88.1.38 · Cited by 1,097 · see citing works
Dietary Flavonoids, Antioxidant Vitamins, and Incidence of Stroke: The Zutphen Study
Keli, S., Hertog, M. G., Feskens, E., & Kromhout, D. (1996) · Archives of Internal Medicine · doi:10.1001/archinte.1996.00440060059007 · Cited by 914 · see citing works
Lifetime Cost of Stroke in the United States
Taylor, T. N., Davis, P. H., Torner, J. C., Holmes, J. S., Meyer, J. W., & Jacobson, M. F. (1996) · Stroke · doi:10.1161/01.str.27.9.1459 · Cited by 806 · see citing works
Dietary flavonoids, antioxidant vitamins, and incidence of stroke: the Zutphen study
Keli, S. O. (1996) · Archives of Internal Medicine · doi:10.1001/archinte.156.6.637 · Cited by 781 · see citing works
Green Tea Consumption and Mortality Due to Cardiovascular Disease, Cancer, and All Causes in Japan
Kuriyama, S., Shimazu, T., Ohmori, K., Kikuchi, N., Nakaya, N., Nishino, Y., Tsubono, Y., & Tsuji, I. (2006) · JAMA · doi:10.1001/jama.296.10.1255 · Cited by 763 · see citing works
The influence of gender and age on disability following ischemic stroke: the Framingham study
Kelly‐Hayes, M., Beiser, A., Kase, C. S., Scaramucci, A., D’Agostino, R. B., & Wolf, P. A. (2003) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/s1052-3057(03)00042-9 · Cited by 729 · see citing works
Physical activity and risk of stroke in women
Hu, F. B. (2000) · JAMA · doi:10.1001/jama.283.22.2961 · Cited by 531 · see citing works
Dietary Flavonoid Intake and Risk of Cardiovascular Disease in Postmenopausal Women
Yochum, L., Kushi, L. H., Meyer, K., & Folsom, A. R. (1999) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009738 · Cited by 436 · see citing works
Does Tea Affect Cardiovascular Disease? A Meta-Analysis
Peters, U. (2001) · American Journal of Epidemiology · doi:10.1093/aje/154.6.495 · Cited by 362 · see citing works
Njelekela, M. A., Yamori, Y., Negishi, H., Xu, J., Ikeda, K., & Nara, Y. (2004) · Journal of Nutrition · doi:10.1093/jn/134.1.38 · Cited by 318 · see citing works
Flavonoid intake and the risk of cardiovascular disease in women
Sesso, H. D., Gaziano, J. M., Liu, S., & Buring, J. E. (2003) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/77.6.1400 · Cited by 317 · see citing works
The Impact of Prevention on Reducing the Burden of Cardiovascular Disease
Kahn, R., Robertson, R. M., Smith, R. A., & Eddy, D. M. (2008) · Circulation · doi:10.1161/circulationaha.108.190186 · Cited by 299 · see citing works
Fitting Categorical Models to Effect Sizes from a Series of Experiments
Hedges, L. V. (1982) · Journal of Educational Statistics · doi:10.3102/10769986007002119 · Cited by 296 · see citing works
Exercise and Risk of Stroke in Male Physicians
Lee, I.-M. M., Hennekens, C. H., Berger, K., Buring, J. E., & Manson, J. E. (1999) · Stroke · doi:10.1161/01.str.30.1.1 · Cited by 272 · see citing works
Alcázar, A., Ballesteros, O., Jurado, J. M., Pablos, F., Martín, M. J., Vilches, J. L., & Navalón, A. (2007) · Journal of Agricultural and Food Chemistry · doi:10.1021/jf070601a · Cited by 250 · see citing works
Projected costs of ischemic stroke in the United States
Brown, D. L., Boden-Albala, B. M., Langa, K. M., Lisabeth, L. D., Fair, M., Smith, M. A., Sacco, R. L., & Morgenstern, L. B. (2006) · Neurology · doi:10.1212/01.wnl.0000237024.16438.20 · Cited by 225 · see citing works
Influence of Patient Age and Stenosis Location on Wingspan In-Stent Restenosis
Turk, A. S., Levy, E. I., Albuquerque, F. C., et al. (2007) · American Journal of Neuroradiology · doi:10.3174/ajnr.a0869 · Cited by 220 · see citing works
Intake of Flavonoids, Carotenoids, Vitamins C and E, and Risk of Stroke in Male Smokers
Hirvonen, T., Virtamo, J. R. K., Korhonen, P. A., Albanes, D., & Pietinen, P. (2000) · Stroke · doi:10.1161/01.str.31.10.2301 · Cited by 212 · see citing works
The cost of cerebral ischaemia
Flynn, R., MacWalter, R. S., & Doney, A. S. F. (2008) · Neuropharmacology · doi:10.1016/j.neuropharm.2008.05.031 · Cited by 204 · see citing works
Klatsky, A. L., Armstrong, M. A., & FRIEDMAN, G. D. (1993) · Annals of Epidemiology · doi:10.1016/1047-2797(93)90064-b · Cited by 195 · see citing works
Risk Factors for Cerebral Hemorrhage in the Era of Well-Controlled Hypertension
Thrift, A. G., McNeil, J. J., Forbes, A. B., & Donnan, G. A. (1996) · Stroke · doi:10.1161/01.str.27.11.2020 · Cited by 176 · see citing works
Xie, J., Wu, E. Q., Zheng, Z.-J., Croft, J. B., Greenlund, K. J., Mensah, G. A., & Labarthe, D. R. (2006) · Stroke · doi:10.1161/01.str.0000240506.34616.10 · Cited by 175 · see citing works
Lee, H., Bae, J. H., & Lee, S. (2004) · Journal of Neuroscience Research · doi:10.1002/jnr.20193 · Cited by 168 · see citing works
Choi, Y. B., Kim, Y.-I., Lee, K. S., et al. (2004) · Brain Research · doi:10.1016/j.brainres.2004.05.079 · Cited by 142 · see citing works
Neuroprotective effect of green tea extract in experimental ischemia-reperfusion brain injury
Hong, J. T., Ryu, S. R., Kim, H. J., Lee, J. K., Lee, S. H., Kim, D. B., Yun, Y. P., Ryu, J. H., Lee, B. M., & Kim, P. Y. (2000) · Brain Research Bulletin · doi:10.1016/s0361-9230(00)00348-8 · Cited by 133 · see citing works
The acute effect of green tea consumption on endothelial function in healthy individuals
Alexopoulos, N. A., Vlachopoulos, C. V., Aznaouridis, K. A., Baou, K., Vasiliadou, C., Pietri, P., Xaplanteris, P., Stefanadi, E., & Stefanadis, C. (2008) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e3282f4832f · Cited by 131 · see citing works
The efficacy of black tea in ameliorating endothelial function is equivalent to that of green tea
Jochmann, N., Lorenz, M., Krosigk, A. V., Martus, P., Böhm, V., Baumann, G., Stangl, K., & Stangl, V. (2007) · British Journal Of Nutrition · doi:10.1017/s0007114507838992 · Cited by 124 · see citing works
Coffee and tea consumption and risk of stroke subtypes in male smokers
Larsson, S. C., Männistö, S., Virtanen, M. J., Kontto, J., Albanes, D., & Virtamo, J. (2008) · Stroke · doi:10.1161/strokeaha.107.504183 · Cited by 122 · see citing works
Ruhparwar, A. (2008) · Circulation · doi:10.1161/circulationaha.107.188511 · Cited by 108 · see citing works
The combined effects of L-theanine and caffeine on cognitive performance and mood
Owen, G. N., Parnell, H., De Bruin, E. A., & Rycroft, J. A. (2008) · Nutritional Neuroscience · doi:10.1179/147683008x301513 · Cited by 103 · see citing works
Possible contribution of green tea drinking habits to the prevention of stroke.
Sato, Y., Nakatsuka, H., WATANABE, T., Hisamichi, S., Shimizu, H., Fujisaku, S., Ichinowatari, Y., Ida, Y., Suda, S., Katō, K., et al. (1989) · The Tohoku Journal of Experimental Medicine · doi:10.1620/tjem.157.337 · Cited by 99 · see citing works
Long-Term Cost of Stroke Subtypes among Medicare Beneficiaries
Lee, W. C., Christensen, M. C., Joshi, A. V., & Pashos, C. L. (2006) · Cerebrovascular Diseases · doi:10.1159/000096542 · Cited by 95 · see citing works
Protective effects of green tea catechins on cerebral ischemic damage.
Suzuki, M., Tabuchi, M., Ikeda, M., Umegaki, K., & Tomita, T. (2004) · PubMed · Cited by 79 · see citing works
Egashira, N., Hayakawa, K., Osajima, M., Mishima, K., Iwasaki, K., Oishi, R., & Fujiwara, M. (2007) · Journal of Pharmacological Sciences · doi:10.1254/jphs.scz070901 · Cited by 79 · see citing works
Green Tea Reduces LDL Oxidability and Improves Vascular Function
Tinahones, F. J., Rubio, M. Á., Garrido‐Sánchez, L., et al. (2008) · Journal of the American College of Nutrition · doi:10.1080/07315724.2008.10719692 · Cited by 59 · see citing works
Kamper, A. M., Spilt, A., de Craen, A. J. M., et al. (2004) · Experimental Gerontology · doi:10.1016/j.exger.2004.04.001 · Cited by 48 · see citing works
Black Tea Consumption and Risk of Rectal Cancer in Moscow Population
Dora, Arab, L., An, M., Сдвижков, А. М., Urbanovich, L., & Weisgerber, U. M. (2003) · Annals of Epidemiology · doi:10.1016/s1047-2797(02)00459-3 · Cited by 37 · see citing works
Self-citation(−)-Epigallocatechin gallate as an intervention for the acute treatment of cerebral ischemia
Rahman, R. M. A., Nair, S. M., Helps, S. C., et al. (2005) · Neuroscience Letters · doi:10.1016/j.neulet.2005.03.018 · Cited by 33 · see citing works
Okamoto, K. (2006) · European Journal of Epidemiology · doi:10.1007/s10654-006-9000-6 · Cited by 30 · see citing works
[A study on the association between tea consumption and stroke].
Chen, Z., Li, Y., Zhao, L.-C., et al. (2004) · PubMed · Cited by 18 · see citing works
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Sorted by citations
Scientific Opinion on the safety of caffeine
EFSA Panel on Dietetic Products, N. A. A. (. (2015) · EFSA Journal · doi:10.2903/j.efsa.2015.4102 · Cited by 613 · see citing works
“One meta-analysis (Arab et al., 2009) of prospective cohort studies which assessed the relationship between green and black tea consumption and the risk of stroke and included data from nine individual studies involving 4 378 strokes among 194 965 individuals in total found similar results.”
ResultHollman, P. C. H., Cassidy, A., Comte, B., Heinonen, M., Richelle, M., Richling, E., Serafini, M., Scalbert, A., Sies, H., & Vidry, S. (2011) · The Journal of Nutrition · doi:10.3945/jn.110.131490 · Cited by 406 · see citing works
Tea and its consumption: Benefits and risks
Hayat, K., Iqbal, H., Malik, U., Bilal, U., & Mushtaq, S. (2015) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2012.678949 · Cited by 405 · see citing works
Rothwell, J. A., Urpi-Sarda, M., Boto-Ordonez, M., Knox, C., Llorach, R., Eisner, R., Cruz, J., Neveu, V., Wishart, D., Manach, C., et al. (2012) · Database · doi:10.1093/database/bas031 · Cited by 188 · see citing works
Liu, Z., Chen, Z., Guo, H., He, D., Zhao, H., Wang, Z., Zhang, W., Liao, L., Zhang, C., & Ni, L. (2016) · Food & Function · doi:10.1039/c6fo01439a · Cited by 185 · see citing works
Tea and cardiovascular disease
Deka, A., & Vita, J. A. (2011) · Pharmacological Research · doi:10.1016/j.phrs.2011.03.009 · Cited by 184 · see citing works
Giesbrecht, T., Rycroft, J. A., Rowson, M. J., & De Bruin, E. A. (2010) · Nutritional Neuroscience · doi:10.1179/147683010x12611460764840 · Cited by 102 · see citing works
Dairy foods and risk of stroke: A meta-analysis of prospective cohort studies
Hu, D., Huang, J., Wang, Y., Zhang, D., & Qu, Y. (2014) · Nutrition, Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2013.12.006 · Cited by 88 · see citing works
Tea drinking and cognitive function in oldest-old Chinese
Feng, L., Li, J., Ng, T.-P., Lee, T.-S., Kua, E.-H., & Zeng, Y. (2012) · The Journal of nutrition, health and aging · doi:10.1007/s12603-012-0077-1 · Cited by 82 · see citing works
“(2) Although we have controlled for major factors that are known to be strongly associated with cognitive performance, it remains possible that residual confounding may still exist owing to imperfect measurement of these factors or lack of control of other potential confounders (3).”
BackgroundLi, Y., Wang, C., Huai, Q., Guo, F., Liu, L., Feng, R., & Sun, C. (2016) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2641 · Cited by 80 · see citing works
Liu, X., Du, X., Han, G., & Gao, W. (2017) · Oncotarget · doi:10.18632/oncotarget.17429 · Cited by 60 · see citing works
l-Theanine promotes nitric oxide production in endothelial cells through eNOS phosphorylation
Siamwala, J. H., Dias, P. M., Majumder, S., Joshi, M. K., Sinkar, V. P., Banerjee, G., & Chatterjee, S. (2013) · The Journal of Nutritional Biochemistry · doi:10.1016/j.jnutbio.2012.02.016 · Cited by 58 · see citing works
Sumathi, T., Shobana, C., Thangarajeswari, M., & Usha, R. (2015) · Drug and Chemical Toxicology · doi:10.3109/01480545.2014.900068 · Cited by 56 · see citing works
Zukhurova, M., Prosvirnina, M., Daineko, A., Simanenkova, A., Petrishchev, N., Sonin, D., Galagudza, M., Shamtsyan, M., Juneja, L. R., & Vlasov, T. (2013) · Phytotherapy Research · doi:10.1002/ptr.4868 · Cited by 42 · see citing works
Lee, J., Lee, J.-E., & Kim, Y. (2017) · Nutrition Journal · doi:10.1186/s12937-017-0232-y · Cited by 27 · see citing works
- Authors
- Arab, L., Liu, W., & Elashoff, D.
- Affiliations
- University of California, Los Angeles (US)
- Venue
- Stroke
- Published
- 2009-05
- Volume
- 40
- Issue
- 5
- Pages
- 1786-1792
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2100046156
- Cited by
- 264
- References
- 48
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 12 · 2023: 6 · 2022: 14 · 2021: 10 · 2020: 15 · 2019: 16 · 2018: 10 · 2017: 9 · 2016: 13 · 2015: 20 · 2014: 28 · 2013: 37 · 2012: 29
- FWCI
- 14.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Tea Polyphenols and Effects
- Health Sciences › Medicine › Pharmacology › Coffee research and impacts
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- green tea, black tea, tea consumption, stroke risk, ischemic stroke, stroke prevention, stroke volume, tea polyphenols
- MeSH terms
- Adult, Aged, Cross-Sectional Studies, Data Interpretation, Statistical, Feeding Behavior, Female, Humans, Male, Middle Aged, Tea, Cohort Studies, Case-Control Studies, Risk Assessment, Stroke, Endpoint Determination, Asian People
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