Quratulain Nauman Shaikh  ( Stroke Research Team, The International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center, Aga Khan University, Karachi. )
Adeel Ali Memon  ( Stroke Research Team, The International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center, Aga Khan University, Karachi. )
Ayeesha Kamran Kamal  ( Stroke Research Team, The International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center, Aga Khan University, Karachi. )

Why is this study important?
One of the world\'s most renowned beverages is tea. Many prospective cohort studies have reported that green tea consumption is linked with reduction in many cardiovascular disease mortalities. Furthermore, coffee is also associated with reduction in diabetes mellitus and cancer. However no large prospective study has reported the combination of green tea and coffee consumption on the incidence of stroke. Since stroke is one of the major cause of morbidity and mortality worldwide, this study aimed to find if green tea and coffee consumption would independently reduce the incidence of stroke.
Who were the participants?
A total of 82,369 Japanese (aged 45-75 years) without cardiovascular disease and cancer were included in the study. Their dietary habits using a food-frequency questionnaire was assessed in 1995 and 1998 who received 13 years of mean follow-up through the end of 2007. Out of the total participants, 43,949 were females and 38,029 were males. Using the choices 0, 1 to 2, 3 to 4 and 5 to 6 times per week, and almost daily, green tea and coffee consumption frequencies were obtained.
What were the results?
In the 1066718 person-years of follow-up, the study documented the incidence of strokes (n=3425) and coronary heart disease (n=910). As compared to seldom drinking green tea, the multivariable-adjusted hazard ratios of all stroke were 0.86 (95% CI, 0.78-0.95) and 0.80 (95% CI, 0.73-0.89) in green tea 2 to 3 and greater than or equal to 4 cups per day, respectively. Compared with seldom drinking coffee, the multivariable-adjusted hazard ratio (95% CI) of all strokes were 0.89 (0.80-0.99), 0.80 (0.72-0.90) and 0.81 (0.72-0.91) for coffee 3 to 6 times per week and 1 and greater than or equal to 2 times per day, respectively. Higher green tea and coffee consumption were inversely associated with CVD and stroke subtypes.
What were the Conclusions?
In general population of Japanese, higher green tea and coffee consumption were inversely associated with the risk of stroke.
What does this mean to our patients?
Tea, like the rest of the world is among the most popular beverages in Pakistan as well. Among different kinds of tea, green tea has recently gained importance in the lives of health conscious people. It appears from this study that higher green tea and coffee consumption reduce the risks of CVD, strokes and its subtypes. It would also be important to study the consumption of regular tea and stroke risk in Pakistanis.
Acknowledgements and Disclosures
Dr. Quratulain Nauman Shaikh is a neurovascular research fellow whose mentored research practicum training is currently funded by Award Number D43TW008660 from the Fogarty International Center and the National Institute of Neurologic Disorders and Stroke. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Center, National Institute of Neurologic Disorders and Stroke or the National Institute of Health.

1. Kokubo Y, Iso H, Saito I, Yamagishi K, Yatsuya H, Ishihara J, et al. The impact of green tea and coffee consumption on the reduced risk of stroke incidence in Japanese population: the Japan public health center-based study cohort. Stroke 2013; 44: 1369-74.
2. Sueoka N, Suganuma M, Sueoka E, Okabe S, Matsuyama S, Imai K, et al. A new function of green tea: prevention of lifestyle-related diseases. Ann N Y Acad Sci 2001; 928: 274-80.
3. Sasazuki S, Inoue M, Hanaoka T, Yamamoto S, Sobue T, Tsugane S. Green tea consumption and subsequent risk of gastric cancer by subsite: the JPHC Study. Cancer Causes Control 2004; 15: 483-91.
4. Kuriyama S, Shimazu T, Ohmori K, Kikuchi N, Nakaya N, Nishino Y, et al. Green tea consumption and mortality due to cardiovascular disease, cancer, and all causes in Japan: the Ohsaki study. JAMA 2006; 296: 1255-65.