"Habitual tea consumption is associated with lower risks of cardiovascular disease and all-cause death," said first author Dr. Xinyan Wang, Chinese Academy of Medical Sciences, Beijing, China. "The favourable health effects are the most robust for green tea and for long-term habitual tea drinkers."

The analysis included 100,902 participants of the China-PAR project with no history of heart attack, stroke, or cancer. Participants were classified into two groups: habitual tea drinkers (three or more times a week) and never or non-habitual tea drinkers (less than three times a week) and followed-up for a median of 7.3 years.

Habitual tea consumption was associated with more healthy years of life and longer life expectancy.

For example, the analyses estimated that 50-year-old habitual tea drinkers would develop coronary heart disease and stroke 1.41 years later and live 1.26 years longer than those who never or seldom drank tea.

Compared with never or non-habitual tea drinkers, habitual tea consumers had a 20% lower risk of incident heart disease and stroke, 22% lower risk of fatal heart disease and stroke, and 15% decreased risk of all-cause death.

The potential influence of changes in tea drinking behavior were analyzed in a subset of 14,081 participants with assessments at two time points. The average duration between the two surveys was 8.2 years, and the median follow-up after the second survey was 5.3 years.

Habitual tea drinkers who maintained their habit in both surveys had a 39% lower risk of incident heart disease and stroke, 56% lower risk of fatal heart disease and stroke, and 29% decreased risk of all-cause death compared to consistent never or non-habitual tea drinkers.

Senior author Dr. Dongfeng Gu, Chinese Academy of Medical Sciences, said: "The protective effects of tea were most pronounced among the consistent habitual tea drinking group. Mechanism studies have suggested that the main bioactive compounds in tea, namely polyphenols, are not stored in the body long-term. Thus, frequent tea intake over an extended period may be necessary for the cardioprotective effect."

In a subanalysis by type of tea, drinking green tea was linked with approximately 25% lower risks for incident heart disease and stroke, fatal heart disease and stroke, and all-cause death. However, no significant associations were observed for black tea.

Dr. Gu noted that a preference for green tea is unique to East Asia. "In our study population, 49% of habitual tea drinkers consumed green tea most frequently, while only 8% preferred black tea. The small proportion of habitual black tea drinkers might make it more difficult to observe robust associations, but our findings hint at a differential effect between tea types."

Two factors may be at play. First, green tea is a rich source of polyphenols which protect against cardiovascular disease and its risk factors including high blood pressure and dyslipidaemia. Black tea is fully fermented and during this process polyphenols are oxidised into pigments and may lose their antioxidant effects. Second, black tea is often served with milk, which previous research has shown may counteract the favorable health effects of tea on vascular function.

Gender-specific analyses showed that the protective effects of habitual tea consumption were pronounced and robust across different outcomes for men, but only modest for women. Dr. Wang said: "One reason might be that 48% of men were habitual tea consumers compared to just 20% of women. Secondly, women had much lower incidence of, and mortality from, heart disease and stroke. These differences made it more likely to find statistically significant results among men."

She added: "The China-PAR project is ongoing, and with more person-years of follow-up among women the associations may become more pronounced."

The authors concluded that randomised trials are warranted to confirm the findings and provide evidence for dietary guidelines and lifestyle recommendations.