PLOS Medicine publishes research and reviews of universal significance that have a clear impact on patient care, public policy, or clinical research agendas.
Role formal analysis, survey, methodology, software, visualization, manuscript writing
School of Public Health, Tianjin Medical University, Tianjin, China
School of Public Health, Tianjin Medical University, Tianjin, China; Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
School of Public Health, Tianjin Medical University, Tianjin, China
https://orcid.org/0000-0001-6380-4127
Department of Genetics, School of Basic Medicine, Tianjin Medical University, Tianjin, China
https://orcid.org/0000-0003-0521-7412
Role conceptualization, data protocol, fund acquisition, investigation, project management, resources, supervision, verification, drafting manuscripts, writing comments and editing
* Email: YaogangWANG@tmu.edu.cn
School of Public Health, Tianjin Medical University, Tianjin, China
https://orcid.org/0000-0003-2493-6471
Previous studies have shown that coffee and tea are related to the development of stroke and dementia. However, little is known about the relationship between the combination of coffee and tea and the risk of stroke, dementia, and post-stroke dementia. Therefore, we aimed to investigate the association between coffee and tea and the risk of stroke and dementia, respectively.
This prospective cohort study included 365,682 participants (50 to 74 years old) from the British Biobank. Participants joined the study from 2006 to 2010 and were followed up until 2020. We use the Cox proportional hazard model to estimate the association between coffee/tea consumption and stroke and dementia, and adjust the index (BMI) according to gender, age, race, qualification, income, weight, physical activity, alcohol status, smoking status, Eating patterns, consumption of sugar-sweetened beverages, high-density lipoprotein (HDL), low-density lipoprotein (LDL), history of cancer, history of diabetes, history of diabetes, cardiovascular disease (CAD), and hypertension. Evaluate coffee and tea consumption at baseline. During a median follow-up of 11.4 years for the emerging disease, 5,079 participants developed dementia and 10,053 participants suffered stroke. The association of coffee and tea with stroke and dementia is non-linear (non-linear P <0.01), coffee intake is 2 to 3 cups/day or tea intake is 3 to 5 cups/day or a combination of both intakes For 4 to 6 cups/day. d Related to the lowest risk ratio (HR) for stroke and dementia. Compared with people who did not drink tea and coffee, patients who drank 2 to 3 cups of coffee and 2 to 3 cups of tea a day had a 32% (HR 0.68, 95% CI, 0.59 to 0.79; P <0.001) risk of stroke and 28% lower (HR, 0.72, 95% CI, 0.59 to 0.89; P = 0.002) The risk of dementia was reduced. In addition, the intake of coffee and tea is associated with a reduced risk of ischemic stroke and vascular dementia. In addition, the combination of tea and coffee is associated with a lower risk of post-stroke dementia, with the lowest risk of post-stroke dementia when drinking 3 to 6 cups of coffee and tea a day (HR, 0.52, 95% CI, 0.32 to 0.83; P = 0.007 ). The main limitation is that coffee and tea intake are self-reported at baseline and may not reflect long-term consumption patterns. Confounding factors not measured in observational studies may lead to biased effect estimates. Participants of the British Biobank cannot represent the entire UK population.
We found that drinking coffee and tea alone or at the same time is associated with a reduced risk of stroke and dementia. Intake of coffee alone or with tea is associated with a reduced risk of dementia after stroke.
Citation: Zhang Y, Yang H, Li S, Li Wd, Wang Y (2021) Coffee and tea consumption and the risk of stroke, dementia, and post-stroke dementia: a cohort study by the British Biobank. PLoS Med 18(11): e1003830. https://doi.org/10.1371/journal.pmed.1003830
Academic Editor: Joshua Z. Willey, Columbia University, USA
Received: February 1, 2021; Accepted: September 30, 2021; Published: November 16, 2021
Copyright: © 2021 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any media, provided the original author and source are indicated.
Data availability: Data from the U.K. Biobank cannot be shared publicly, however, data can be obtained from the U.K. Biobank Institutional Data Access/Ethics Committee (contact http://www.ukbiobank.ac.uk/ or contact access@ by email ukbiobank.ac.uk) is for researchers who meet the criteria for accessing confidential data.
Funding: This research was funded by the National Natural Science Foundation of China (approval number: 91746205: http://www.nsfc.gov.cn/english/site_1/index.html) and received by YW. The funder has no role in research design, data collection and analysis, publication decision or manuscript preparation.
Competing interests: The author declares that there are no competing interests.
Abbreviations: A, advanced; ANOVA, analysis of variance; AS, advanced subsidiary; BMI, body mass index; CAD, cardiovascular disease; CSE, certificate of secondary education; cardiovascular disease, cardiovascular disease; DBP, diastolic blood pressure; GCSE, General Certificate of Secondary Education; HDL, High Density Lipoprotein; HNC, National Advanced Certificate; HND, National Higher Diploma; HR, Hazard Ratio; ICD-10, International Classification of Diseases-Tenth Revision; Low Density Lipoprotein, Low Density Lipid Protein; NHS, National Health Service; NVQ, National Occupational Qualification; O, General; SBP, Systolic Blood Pressure; SD, Standard Deviation; STROBE, Report on Strengthening Epidemiological Observational Research
Dementia is characterized by deteriorating mental capacity, which inevitably damages independent life [1]. Alzheimer's disease and vascular dementia are the two main subtypes of dementia. Dementia is more a clinical symptom rather than a specific disease. It can be induced by brain degeneration, cerebrovascular disease, brain trauma, brain tumor, intracranial infection, metabolic disease and poisons. With the aging trend of the population, dementia has become a health problem of increasing concern around the world, and brings a heavy economic and social burden. In 2019, more than 50 million people worldwide suffered from dementia. It is estimated that by 2050, this number will increase to 152 million [2]. In view of the limited therapeutic value of the drugs currently used to treat dementia, determining the preventable risk factors of dementia is a top priority.
Stroke accounts for 10% of all deaths in the world [3] and is the main cause of all disability-adjusted life years [4]. Although the age-standardized morbidity and mortality of stroke have declined in the past 20 years, the absolute number of stroke cases and deaths has increased [5]. Stroke and dementia give each other risks and share some of the same risk and protective factors that can be changed to a large extent. A population-based longitudinal study found that the risk and protective factors of stroke and dementia accounted for about 60% [6]. In principle, it is estimated that 90% of strokes and 35% of dementias can be prevented [7-10]. Since stroke doubles the chance of developing dementia, and stroke is more common than dementia, more than one-third of dementia cases can be prevented by preventing stroke [10].
Coffee and tea are among the most widely consumed beverages in the UK and globally. Coffee contains caffeine, which is a rich source of antioxidants and other biologically active compounds [11]. According to reports, tea containing caffeine, catechin polyphenols and flavonoids has neuroprotective effects, such as anti-oxidative stress, anti-inflammatory, inhibition of amyloid β aggregation and anti-apoptotic effects [12]. Coffee consumption is closely related to tea consumption. A prospective cohort study reported that approximately 70% of participants drank coffee and tea at the same time [13]. Coffee and tea are different beverages with overlapping ingredients, such as caffeine and different biologically active ingredients, including epigallocatechin gallate and chlorogenic acid [14]. These components seem to have a common mechanism-reactive oxygen species. On the other hand, different components also have different target molecules, so they have different biological effects [14]. In addition, the genetic polymorphisms of enzymes involved in the absorption, metabolism and excretion of tea and coffee components are also related to the different biological activities of the two beverages [15]. In addition, studies have found that the interaction between green tea and coffee has an impact on the health outcomes of the Japanese population [13,16]. A research cohort based on the Japan Public Health Center reported that there is a multiplicative interaction between green tea and coffee, which is associated with a lower risk of cerebral hemorrhage [16]. A prospective study showed that green tea and coffee seem to have an additive interaction on the mortality of Japanese type 2 diabetes patients [13]. Epidemiological and clinical studies have shown that coffee and tea are good for preventing dementia respectively [17-22]. However, little is known about the association between the combination of coffee and tea and the risk of dementia. Therefore, we aim to explore the association between the combination of coffee and tea (perhaps multiplicative or additive interaction) and the risk of stroke and dementia.
Post-stroke dementia refers to any dementia that occurs after a stroke [23]. Dementia after stroke is a major public health problem, and 30% of stroke survivors suffer from dementia [23,24]. Therefore, it is very important to identify and prevent the influencing factors of post-stroke dementia. Epidemiological studies have found that there is a negative correlation between coffee and tea and stroke and dementia [25-28], but the relationship between coffee and tea intake and post-stroke dementia is still unclear. Therefore, the purpose of this study is to investigate the association of coffee and tea with the risk of stroke, dementia, and post-stroke dementia based on data from a large population cohort.
This study is reported in accordance with the STROBE Guidelines (S1 List). UK Biobank has received ethical approval from the Northwest Multi-Center Research Ethics Committee (11/NW/0382). Appropriate informed consent was obtained from the participants, and ethical approval was covered by the British Biobank. This research was carried out using the resources of the British Biobank, the project number is 45676. The analysis is planned to be drafted forward in February 2020 (S1 text).
The UK Biobank includes data from a population-based cohort study that recruited more than 500,000 participants (39 to 74 years old) who participated in one of 22 assessment centers in the UK between 2006 and 2010 [29 ]. The analysis is limited to individuals who are at least 50 years of age at baseline (because most cases of dementia and stroke occur in the elderly). Participants provided extensive information through questionnaires, interviews, health records, physical measurements, and blood samples. Our analysis in this study excluded data from self-reported stroke or dementia patients at baseline, or diagnosed stroke or dementia data identified in hospital records. In our current study, data from 365,682 individuals can be used for analysis.
A touch screen questionnaire was used to assess coffee intake at baseline. Participants were asked, "How many cups of coffee do you drink every day (including decaffeinated coffee)?" Participants choose one of the following options: "less than one", "don't know", "do not want to answer" or drink daily A specific amount of coffee. If participants report drinking more than 10 cups per day, they will be asked to confirm their reaction. In addition, coffee drinkers were also asked "What type of coffee do you usually drink?" Then they were asked to choose 1 out of 6 mutually exclusive answers, as follows: "Decaf coffee (any type)", “Instant coffee”, “ground coffee (including espresso and filter coffee), “other types of coffee”, “do not know” or “do not want to answer.” Then, we analyzed the relationship between different coffee types and the risk of stroke and dementia ’S association.
A touch screen questionnaire was used to assess tea intake at baseline. Participants were asked, "How many cups of tea do you drink each day (including black tea and green tea)?" Participants choose one of the following options: "less than one", "don't know", "do not want to answer" or drink a certain amount of tea each day Tea. If participants report drinking more than 10 cups per day, they will be asked to confirm their reaction.
Use hospital admission records to determine the results, which include admission and diagnosis data obtained from hospital event statistics in England, Scottish incidence records in Scotland, and patient event databases in Wales. Use the 10th edition of the International Classification of Diseases (ICD-10) coding system to record the diagnosis. The main outcome of this study is the stroke event and its two main component endpoints-ischemic stroke and hemorrhagic stroke, dementia, and its two main endpoints-Alzheimer's disease and vascular dementia. In addition, the outcomes of Alzheimer's disease, vascular dementia, ischemic stroke, and hemorrhagic stroke were evaluated separately. We define outcomes based on ICD-10: stroke (I60, I61, I62.9, I63, I64, I67.8, I69.0 and I69.3), ischemic stroke (I63), hemorrhagic stroke (I60 and I62) .9), dementia (F00, F01, F02, F03, F05.1, G30, G31.1 and G31.8), Alzheimer's disease (F00 and G30) and vascular dementia (F01).
In this study, the choice of covariates was based on (1) demographic variables, including gender, age, ethnic background, education level, and income; (2) prior knowledge of potential confounding factors related to stroke and dementia [30, 31]. Covariates are documented, including gender, age, race (white, Asian or Asian British, black or black British, and other ethnic groups), qualifications (university or university degree, advanced [A] level/advanced affiliated [AS] ] Level or equivalent, general [O] level/General Certificate of Secondary Education [GCSE] or equivalent, Certificate of Secondary Education [CSE] or equivalent, National Vocational Qualification [NVQ] or Advanced National Diploma [HND] or Advanced National Certificate [HNC] or equivalent, other professional qualifications, or none of the above), income (less than £18,000, 18,000 to 30,999, 31,000 to 51,999, 52,000 to 100,000 and greater than 100,000), BMI (<25, <25 to 35 to BMI), and ≥35 kg/m2), smoking status (never, before and now), alcohol status (never, before and now), physical activity (low, medium, and high), consumption of sugary drinks, history Diabetes, history of coronary artery disease, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and diet patterns (healthy and unhealthy healthy diets are based on eating at least 4 of 7 dietary components: (1) Fruits: ≥3 servings/day; (2) Vegetables: ≥3 servings/day; (3) Fish: ≥2 servings/week; (4) Processed meat: ≤1 servings/week; (5) Unprocessed red meat: ≤1.5 servings/week; (6) Whole grains: ≥3 servings/day; (7) Refined cereals: ≤1.5 servings/day [32–35]) (S1 table).
Information about cardiovascular artery disease (CAD) comes from medical records (ICD-10 codes I20 to I25). Diabetes is determined based on medical records (ICD-10 codes E10 to E14), glycosylated hemoglobin ≥6.5%, and use of anti-diabetic drugs. Hypertension is defined as systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg, use of antihypertensive drugs or medical records (ICD-10 codes I10 to I13 and I15). Cancer is determined through contact with the National Health Service (NHS) Central Register (ICD-10 codes C00 to C97).
The baseline characteristics of the samples are summarized in the tea and coffee intake as the percentage of categorical variables and the mean and standard deviation (SD) of continuous variables. Use analysis of variance (ANOVA) or Mann-Whitney U test for continuous variables and chi-square test for categorical variables to compare baseline characteristics of the study population in the category of coffee or tea intake. The restricted cubic spline model is used to evaluate the relationship between coffee, tea, and their combinations and stroke and dementia events. The 25th, 50th, 75th, and 95th quantiles are 4 sections. In the spline model, we adjusted gender, age, race, education, income, body mass index (BMI), physical activity, alcohol status, smoking status, eating pattern, consumption of sugary drinks, HDL, LDL, cancer, diabetes History, history of coronary heart disease, and hypertension; in addition, we adjusted for coffee in tea analysis or tea in coffee analysis. In order to analyze the association between coffee and tea intake categories and new disease outcomes, we defined coffee and tea intake as the following categories: 0, 0.5 to 1, 2 to 3, and ≥ 4 cups/day. We used the Cox proportional hazards model to estimate the association between coffee and tea intake categories and the incidence of stroke and dementia. The Schoenfeld residual method was used to test the proportional hazards hypothesis of the Cox model; no violation of the hypothesis was found. The duration of follow-up is calculated as the time scale between the baseline assessment and the first stroke or dementia, death, loss to follow-up, or June 31, 2020 (the date of last admission). The Cox regression model was adjusted for gender, age, race, qualifications, income, BMI, physical activity, alcohol status, smoking status, cancer history, diabetes history, CAD history, HDL, LDL, eating patterns, and sugar consumption. For sugar-sweetened beverages and high blood pressure, we adjusted the coffee in the tea analysis or the tea in the coffee analysis. If the covariate information is missing (<20%), we use multiple imputation based on 5 repetitions and the chain equation method in the R MI program to explain the missing data. The S2 table shows detailed information about the missing data. We also used Cox regression to assess the association of coffee and tea with dementia in stroke patients. The P value used for heterogeneity corresponds to the chi-square test statistic of the likelihood ratio test, comparing the model with and without the interaction between coffee and tea.
Several additional analyses were performed to assess the robustness of our research results. First, we used a stratified analysis to examine whether the association between tea and coffee and the risk of stroke and dementia is dependent on age (<65 years vs ≥65 years), gender, smoking status, alcohol status, physical activity, BMI, and eating patterns. Different. In a series of sensitivity analyses, we explored the occurrence of stroke and dementia by excluding participants with major pre-existing diseases (for example, diabetes, CAD, and cancer) at baseline and excluding events that occurred during the first 2 years of follow-up. risk. In addition, we analyzed by including participants under the age of 50, and made more detailed adjustments to smoking (never smokers, former smokers quit smoking 5 years ago, former smokers quit smoking ≤ 5 years, current smokers <10 sticks/year). Every day, current smokers use 10 to 20 cigarettes per day, current smokers have more than 20 cigarettes per day) and alcohol status (never drinkers, former drinkers, current drinkers <7 grams per day, current drinkers 7 to 16 grams per day , And current drinkers)> 16 g/day). Finally, we used the sub-distribution method proposed by Fine and Gray to assess the association between the risk of non-stroke or non-dementia death and the combination of tea and coffee and the risk of stroke and dementia [36]. All P values are 2-sided, and the statistical significance is set to be less than 0.05. All analyses were performed using R software version 3.6.1 and STATA 15.
At baseline, 502,507 participants were evaluated. After excluding participants who were younger than 50 years (n = 132,168), had no information on tea or coffee intake (n = 2,074), had stroke or dementia (n = 2,583), 365,682 participants were eventually included In this study, coffee and tea (S1A chart) were evaluated for the association of stroke and dementia. Among the 502,507 participants, those who had not had a stroke as of June 31, 2020 (n = 488,581), had no information on tea or coffee intake (n = 114), and had dementia before the stroke (n = 460) were excluded After the number of participants, 13,352 participants were eventually included in this study to evaluate the association between coffee and tea and post-stroke dementia (S1B figure).
Among the 365,682 participants, the average age was 60.4 ± 5.1 years, of which 167,060 (45.7%) were men. In total, 75,986 (20.8%) participants did not drink coffee and 50,009 (13.7%) participants did not drink tea. The distribution of the combination of coffee and tea intake is shown in Figure S2. Among 365,682 participants, 59,558 (16.29%) participants reported drinking 0.5 to 1 cup of coffee and ≥4 cups of tea per day, accounting for the largest proportion, followed by 50,015 (13.68%) participants reporting drinking 0 cups of coffee and ≥4 cups of tea; in addition, 44,868 (12.27%) participants reported drinking 2 to 3 cups of coffee and 2 to 3 cups of tea per day. Table 1 provides the baseline characteristics of the participants. Compared with the characteristics of participants who did not drink coffee, coffee drinkers were more likely to be male, white, former smoker, current drinker, college degree and high income. Similarly, compared with people who do not drink tea, people who drink tea are more likely to be men, never smokers, current drinkers, have a college degree and have high physical activity. In addition, compared with participants who drank neither coffee nor tea, participants who drank both beverages were more likely to be elderly, male, white, former smoker, current drinker, have a college degree, and have a high income ( S3 table). Coffee intake (cup/day) was correlated with tea intake (r = -0.337, P <0.001). Drinking coffee and tea are related to gender, age, race, qualifications, income, BMI, physical activity, alcohol status, smoking status, consumption of sugar-sweetened beverages, low-density lipoprotein, cancer, diabetes, and coronary heart disease. Density lipoprotein is irrelevant (S4 table). During a median follow-up of 11.35 years for the emerging disease, 10,053 participants (2.8%) developed strokes (5,630 ischemic strokes and 1,815 hemorrhagic strokes), and 5,079 participants (1.4%) developed dementia ( 2,128 with Alzheimer’s disease and 1,223 with vascular dementia).
https://doi.org/10.1371/journal.pmed.1003830.t001
The restricted cubic spline model is used to evaluate coffee, tea and their relationship with stroke, dementia, and post-stroke dementia. In the unadjusted (S3 chart) and multi-adjusted models (Fig. 1), the combination of coffee and tea is associated with stroke, dementia, and post-stroke dementia. In the multi-adjustment model, the association of coffee and tea with stroke and dementia is non-linear (non-linear P <0.001), coffee intake is 2 to 3 cups/day or tea intake is 3 to 5 cups/day, respectively , Or 4 to 6 cups/day of coffee and tea at the same time is associated with the lowest risk ratio (HR) for stroke and dementia. In addition, the combination of tea and coffee is associated with a lower risk of post-stroke dementia. Drinking 3 to 6 cups of coffee and tea daily has the lowest risk of post-stroke dementia (HR, 0.52, 95% CI, 0.32 to 0.83; P = 0.007).
(A1) Coffee and stroke. (A2) Tea and stroke. (A3) The combination of coffee and tea during stroke. (B1) Coffee and dementia. (B2) Tea and dementia. (B3) Combination of coffee and tea to treat dementia. (C1) Coffee and post-stroke dementia. (C2) Tea and post-stroke dementia. (C3) The combination of coffee and tea treats post-stroke dementia. The 95% CI of the adjusted HR is represented by the shaded area. Restricted cubic spline model for gender, age, race, qualification, income, BMI, smoking status, alcohol status, physical activity, eating pattern, consumption of sugary drinks, HDL, LDL, cancer, diabetes, CAD, and high blood pressure Adjustments, we adjusted for coffee in tea analysis or tea in coffee analysis. BMI, body mass index; CAD, cardiovascular artery disease; HDL, high-density lipoprotein; HR, risk ratio; low-density lipoprotein, low-density lipoprotein.
https://doi.org/10.1371/journal.pmed.1003830.g001
In order to analyze the association between coffee and tea intake and new disease outcomes, we defined coffee and tea intake into the following categories: 0, 0.5 to 1, 2 to 3, and ≥ 4 cups/day. We investigated the association between each type of coffee and tea intake and stroke and its subtypes (Figure 2). In the unadjusted Cox model, coffee and tea intake is associated with a lower risk of stroke (S5 table). After multivariate adjustments, coffee intake was associated with a reduced risk of stroke. Compared with people who did not drink coffee, the HR (95% CI) for coffee intake of 0.5 to 1, 2 to 3 cups/day and ≥ 4 cups/day was 0.90 (95% CI, 0.85 to 0.95; P < 0.001), 0.88 (95% CI, 0.84 to 0.94; P <0.001), and 0.92 (95% CI, 0.86 to 0.98; P = 0.009). Similarly, after multivariate adjustments for confounding factors, tea intake was associated with a reduced risk of stroke. The stroke HRs (95% CI) for tea intake 0.5 to 1, 2 to 3 and ≥ 4 cups/day were 0.97 (95% CI, 0.89 to 1.04; P = 0.386), 0.84 (95% CI, 0.79 to 0.90) ; P <0.001) and 0.84 (95% CI, 0.79 to 0.90; P <0.001). In addition, each type of coffee and tea was associated with a lower risk of ischemic stroke, but not associated with hemorrhagic stroke (P> 0.05).
(A) Coffee and tea for stroke. (B) Coffee and tea for ischemic stroke. (C) Coffee and tea for hemorrhagic stroke. Multivariate models are based on gender, age, race (white, Asian or Asian British, black or black British, and other races), qualifications (university or university degree, A level/AS level or equivalent, O level/GCSE or equivalent Adjusted academic qualifications, CSE or equivalent, NVQ or HND or HNC or equivalent, other professional qualifications or above none), income (less than £18,000, 18,000 to 30,999, 31,000 to 51,999, 52,000 to 100,000 and greater than 10,000 BMI ) (<25, 25 to <30, 30 to <35 and ≥35 kg/m2), smoking status (never, before and now), alcohol status (never, before and now), physical activity (low, moderate) , High), diet patterns (healthy and unhealthy, produced by fruits, vegetables, fish, processed meats, unprocessed red meat, whole grains, and refined grains), consumption of sugar-sweetened beverages, high-density lipoproteins, low-density lipoproteins , Cancer, diabetes, CAD, and high blood pressure, we adjusted for coffee in tea analysis or tea in coffee analysis. A. Senior; AS, senior subsidiary; BMI, body mass index; CAD, cardiovascular artery disease; CSE, certificate of secondary education; GCSE, general certificate of secondary education; HDL, high-density lipoprotein; HNC, national advanced certificate; HND, National Higher Diploma; HR, risk ratio; low-density lipoprotein, low-density lipoprotein; NVQ, national vocational qualification; oh, ordinary.
https://doi.org/10.1371/journal.pmed.1003830.g002
In addition, we examined the joint association between coffee and tea intake and stroke and its subtypes (Figure 2). We found that in the unadjusted (S5 table) and multi-adjusted models (Figure 2), the combination of coffee and tea was associated with a lower risk of stroke and ischemic stroke. In the multiple-adjusted model, compared with people who did not drink tea and coffee, the HRs of drinking 2 to 3 cups of coffee and 2 to 3 cups of tea per day were 0.68 (95% CI, 0.59 to 0.79; P <0.001) and 0.62, respectively (95% CI, 0.51 to 0.75; P <0.001) were used for stroke and ischemic stroke, respectively. However, no association of coffee and tea with hemorrhagic stroke was observed. There was a statistical interaction between tea and coffee intake and stroke (P <0.001).
We assessed the association of each type of coffee and tea with dementia and its subtypes (Figure 3). In the unadjusted Cox model, the consumption of coffee, tea, and combinations thereof was associated with a reduced risk of dementia and vascular dementia, but not with Alzheimer's disease (S6 table). After multivariate adjustments for confounding factors, coffee intake was associated with a reduced risk of dementia and vascular dementia, but not with Alzheimer's disease. Similarly, after multivariate adjustment, tea intake was associated with a decrease in the risk of dementia and vascular dementia, but not with Alzheimer's disease. Next, we assessed the association between coffee and tea intake and dementia and its subtypes. We have found that drinking 0.5 to 1 cup of coffee and ≥ 4 cups of tea a day has the lowest risk of dementia. Compared with people who did not drink coffee and tea, the HR (95% CI) for drinking 0.5 to 1 cup of coffee and ≥4 cups of tea per day was 0.70 (95% CI, 0.58 to 0.86; P <0.001), and drinking 2 cups per day The HR (95% CI) for to 3 cups of coffee and 2 to 3 cups of tea was 0.72 (95% CI, 0.59 to 0.89; P = 0.002). There was a statistical interaction between tea and coffee intake on dementia and vascular dementia (P = 0.0127). In addition, coffee and tea intake is associated with a reduced risk of vascular dementia, but not with Alzheimer's disease.
(A) Coffee and tea with dementia. (B) Coffee and tea with Alzheimer's disease. (C) Coffee and tea for vascular dementia. Multivariate models are based on gender, age, race (white, Asian or Asian British, black or black British, and other races), qualifications (university or university degree, A level/AS level or equivalent, O level/GCSE or equivalent Adjusted academic qualifications, CSE or equivalent, NVQ or HND or HNC or equivalent, other professional qualifications or above none), income (less than £18,000, 18,000 to 30,999, 31,000 to 51,999, 52,000 to 100,000 and greater than 10,000 BMI ) (<25, 25 to <30, 30 to <35 and ≥35 kg/m2), smoking status (never, before and now), alcohol status (never, before and now), physical activity (low, moderate) , High), diet patterns (healthy and unhealthy, produced by fruits, vegetables, fish, processed meats, unprocessed red meat, whole grains, and refined grains), consumption of sugar-sweetened beverages, high-density lipoproteins, low-density lipoproteins , Cancer, diabetes, CAD, and high blood pressure, we adjusted for coffee in tea analysis or tea in coffee analysis. A. Senior; AS, senior subsidiary; BMI, body mass index; CAD, cardiovascular artery disease; CSE, certificate of secondary education; GCSE, general certificate of secondary education; HDL, high-density lipoprotein; HNC, national advanced certificate; HND, National Higher Diploma; HR, risk ratio; low-density lipoprotein, low-density lipoprotein; NVQ, national vocational qualification; oh, ordinary.
https://doi.org/10.1371/journal.pmed.1003830.g003
In addition, we evaluated the HR of participants who drank coffee and tea at the same time and participants who only drank coffee or tea (S7 sheet). After adjusting for confounding factors, compared with participants who only drank coffee or tea, participants who drank coffee and tea at the same time had a lower risk of stroke (HR, 0.89; 95% CI, 0.86 to 0.93; P <0.001), ischemic Stroke (HR, 0.89; 95% CI, 0.84 to 0.94; P <0.001), dementia (HR, 0.92; 95% CI, 0.87 to 0.98; P = 0.001) and vascular dementia (HR, 0.82; 95% CI, 0.7) to 0.92; P <0.001).
We further studied the association of coffee and tea with dementia and its subtypes in stroke participants (Figure S4). Of the 13,352 stroke participants, 646 participants (4.8%) developed dementia (119 Alzheimer's disease and 315 vascular dementia) during a median follow-up of 7.07 years. In the unadjusted Cox model, coffee and a combination of coffee and tea are associated with a lower risk of dementia (S8 table). After multivariate adjustment, participants who drank 2 to 3 cups of coffee a day had a lower risk of dementia compared with those who did not drink coffee (HR, 0.80; 95% CI, 0.64 to 0.99; P = 0.044), but It has nothing to do with Alzheimer's disease and vascular dementia. In addition, compared with not drinking tea, drinking tea has nothing to do with dementia and its subtypes in stroke participants. Next, we evaluated the effect of the combination of coffee and tea intake on dementia and its subtypes in stroke participants. We found that the combination of coffee and tea is associated with a reduced risk of dementia after stroke. Compared with people who did not drink coffee and tea, the HR for post-stroke dementia who drank 0.5 to 1 cup of coffee and 2 to 3 cups of tea per day was 0.50 (95% CI, 0.31 to 0.82; P = 0.006). However, no associations have been observed between coffee and tea, Alzheimer's disease and vascular dementia. There was no interaction between tea and coffee intake and dementia and vascular dementia (P> 0.05).
We also assessed the association between coffee type and stroke (S9 list) and dementia (S10 list). Among coffee drinkers, 160,741 (44.0%), 63,363 (17.3%), and 57,397 (15.7%) of the participants reported drinking instant coffee, ground coffee, and decaffeinated coffee. In the multiple-adjusted Cox regression model, compared with instant coffee, ground coffee was not associated with stroke (HR, 0.98; 95% CI, 0.93 to 1.04; P = 0.619) and its subtypes. Compared with decaffeinated coffee, instant coffee is not associated with stroke (HR, 0.95; 95% CI, 0.90 to 1.01; P = 0.074) and its subtypes, while ground coffee is associated with a lower risk of stroke (HR, 0.90, 95% CI, 0.84 to 0.97; P = 0.006) and ischemic stroke (HR, 0.90, 95% CI, 0.82 to 1.00; P = 0.045). For dementia, in the multiple-adjusted Cox regression model, compared with instant coffee, coffee powder is associated with dementia (HR, 0.83; 95% CI, 0.77 to 0.89; P <0.001), Alzheimer's disease (HR, 0.77; 95% CI, 0.69 to 0.87; P <0.001) and vascular dementia (HR, 0.82; 95% CI, 0.70 to 0.96; P = 0.012). Compared with decaffeinated coffee, instant coffee is associated with dementia (HR, 0.85; 95% CI, 0.79 to 0.92; P <0.001), Alzheimer's disease (HR, 0.81; 95% CI, 0.72 to 0.91; P <0.001) associated with reduced risk) and vascular dementia (HR, 0.84; 95% CI, 0.72 to 0.99; P = 0.036); coffee powder and dementia (HR, 0.74; 95% CI, 0.66 to 0.82; P < 0.001), Alzheimer's disease (HR, 0.67; 95% CI, 0.57 to 0.78; P <0.001) is associated with a reduced risk of vascular dementia (HR, 0.74; 95% CI, 0.59 to 0.92; P = 0.008) .
When the analysis was stratified by age, the association between the combination of coffee and tea and stroke risk was more pronounced in individuals aged 50 to 65 (interaction P = 0.044; S11 table), but not dementia (interaction P = 0.091; S12 table). The association between coffee/tea intake and stroke and dementia was not significant between gender (S13 and S14 tables), smoking status (S15 and S16 tables), alcohol status (S17 and S18 tables), and physical activity (S19 and S20 tables). Significant differences, BMI (S21 and S22 tables), and eating patterns (S23 and S24 tables) (all Ps indicate interaction> 0.05). When we repeated the analysis, the results did not change much compared with the results of the initial analysis: (1) Exclude participants who had stroke or dementia during the first 2 years of follow-up (S25 and S26 tables); (2) Exclude the patients at baseline Participants with major pre-existing diseases (for example, cancer, coronary artery disease, and diabetes) (S27 and S28 forms); (3) Including participants under 50 years of age (S29 and S30 forms); (4) Regarding smoking and drinking status Make more detailed adjustments (S31 and S32 tables); (4) Use competitive risk regression models (S33 and S34 tables).
In this large prospective cohort study, we found that (1) the consumption of tea and coffee alone and in combination was associated with a reduced risk of stroke, ischemic stroke, dementia, and vascular dementia; (2) reported drinking 2 to 3 daily Participants with cups of coffee and 2 to 3 cups of tea had a 30% lower risk of stroke and dementia; (3) Compared with drinking coffee or tea alone, the combination of coffee and tea seems to be associated with a lower risk of stroke and dementia Related; (4) Ingestion of coffee alone or with tea is associated with a reduced risk of dementia after stroke.
Many studies have investigated the relationship between drinking coffee and tea alone and stroke, but the results are inconsistent. Some report reverse associations [37,38], while others show positive or empty connections [16,28,39-41]. Our findings support that drinking tea and coffee are associated with reducing the risk of stroke, and are consistent with the review summarizing existing evidence from experimental studies, prospective studies, and meta-analysis. The report stated that drinking tea and coffee may be associated with reducing the risk of stroke [41] ]. The current study also found that the combination of tea and coffee has a stronger association with ischemic stroke than hemorrhagic stroke. Studies have reported that, due to the different pathogenesis and pathophysiology of stroke subtypes, coffee and tea may have different effects on different stroke subtypes [42,43]. One possible mechanism of this relationship is that coffee and tea are negatively related to endothelial dysfunction, which is the main cause of ischemic stroke [44-47]. Another potential mechanism may be that coffee contains caffeine, which is a rich source of antioxidants. There is evidence that coffee is negatively associated with cardiometabolic risks, including cardiovascular disease (CVD), type 2 diabetes, blood lipids, and hypertension [25 ,48,49]. Although these explanations are biologically reasonable, further research is necessary to provide the exact underlying mechanism of coffee and tea intake in the occurrence of ischemic stroke.
A previous study supports the association of a combination of coffee and tea with stroke. Kokubo and colleagues conducted a prospective study that included 82,369 Japanese people aged 45 to 74. The study found that the higher the intake of green tea or coffee, the cardiovascular disease and stroke subtypes (especially cerebral hemorrhage) ) The lower the risk [16]. The difference is that our research results show that coffee and tea intake is related to ischemic stroke rather than hemorrhagic stroke. The reasons for this difference may be research design, ethnic background, and tea consumption classification. Further experimental research is needed to verify our findings. In addition, Gelber and colleagues conducted the Honolulu-Asian Aging Study, which included 3,494 men. The study found that coffee and caffeine intake in middle age was associated with overall dementia, Alzheimer’s disease, vascular dementia or recognition. The barrier to knowledge has nothing to do with [22], it is related to our findings. The reason for this difference may be the sample size.
Our research shows that there are interactions between coffee and tea related to stroke and dementia. There are multiple mechanisms by which the combination of coffee and tea may be associated with stroke and dementia. First, coffee is the main source of caffeine, containing phenolic substances and other biologically active compounds with potentially beneficial health effects. Similarly, tea contains caffeine, catechin polyphenols and flavonoids, which are reported to have neuroprotective effects such as anti-oxidative stress, anti-inflammatory, inhibition of amyloid β aggregation and anti-apoptosis [18,50,51 ]. Coffee and tea are different beverages, with both overlapping and different contents [14]. A potential mechanism may be related to the comprehensive protective effects of different antioxidants and other biological components in these two beverages [16]. Secondly, coffee and tea have specific polyphenol content. The former contains hydroxycinnamic acid and the latter contains catechins. They have potential benefits in improving endothelial function, insulin resistance and anti-inflammatory, and they have different target molecules. [52] ]; Therefore, the specific polyphenol content in coffee and tea may play a comprehensive protective role in the pathogenesis of stroke and dementia. Third, both coffee and tea are associated with lower cardiometabolic risks, including type 2 diabetes, hypertension, and CAD [25,48,49]. Therefore, the combined consumption of these two beverages may have common health benefits in preventing the risk of stroke and dementia. Fourth, the interaction between coffee and tea drinking in stroke and dementia may have occurred by chance. Finally, coffee and tea intake may jointly regulate the activation of certain cytokines [53-55]. It is necessary to conduct further verification in animal experiments to examine the potential joint association of coffee and tea on dementia.
The advantages of this study include the large sample size, prospective design, and long-term follow-up of UK Biobank participants. Our current research also has some limitations. First, coffee and tea intake are self-reports at baseline, which may not reflect long-term consumption patterns. Potential changes in coffee and tea consumption after the baseline inspection may have affected our risk estimates. Future research needs to investigate the impact of changes in coffee and tea intake over time on the risk of stroke and dementia. Second, coffee and tea intake are both self-reported measures, which may lead to inaccurate responses, although most large epidemiological studies rely on self-reported questionnaires. Third, on average, the health awareness of volunteers in the British Biobank cohort is often higher than that of non-participants, which may lead to underestimation of the prevalence and incidence of stroke and dementia [56]. Fry and colleagues report that UK Biobank participants generally live in areas with lower socioeconomic poverty; are less likely to be obese, smoke or drink alcohol; and have fewer self-reported health conditions, and there is evidence that “healthy Volunteers’ selection bias [56]. Fourth, similar to most observational studies, although multiple sensitivity analyses were performed in the current study, biases that may be caused by unmeasured confounding factors (for example, mental illness, sleep patterns, and genetic predispositions) still exist. In addition, considering that the absolute proportion of participants in major events is relatively low, there may be residual confounding based on baseline demographic data and risk factors, as well as unmeasured confounding and healthy lifestyles that are more likely to occur in certain types of tea. Coffee drinker. Therefore, the conclusion may be influenced by low absolute risk and possible residual confounding factors. Finally, since most of the participants in the British Biobank are British whites (96%), our findings may only be generalized to demographically similar cohorts, and this restriction excludes the possibility of generalizing these findings to the general population sex.
In neurological diseases, stroke (42%) and dementia (10%) dominate [10]. A stroke can cause cognitive impairment and even post-stroke dementia. In addition, recessive stroke and asymptomatic cerebral ischemia can cause cognitive impairment and dementia [10]. Therefore, prevention of the risk of stroke and dementia is particularly important. Although progress has been made in understanding the pathophysiology of stroke and dementia, the clinical treatment of stroke and dementia is still not ideal. Therefore, identifying preventable risk factors for stroke and dementia is a top priority. Our findings raise the possibility of a potentially beneficial association between moderate coffee and tea consumption and the risk of stroke and dementia, although this study was unable to establish a causal relationship. Lifestyle interventions, including promoting healthy dietary intake (for example, drinking coffee and tea in moderation), may benefit older people by improving stroke and subsequent dementia. From a public health perspective, because people who regularly drink tea and coffee account for a large proportion of the population, and these beverages are often habitually consumed throughout adulthood, even with the small potential health benefits associated with tea and coffee intake Or the risk may also have an important impact on the public. Health impact. Further clinical trials of lifestyle interventions are needed to assess whether the observed association is causal.
In summary, we found that drinking coffee and tea alone or at the same time is associated with a reduced risk of stroke and dementia. In addition, drinking coffee alone or with tea is associated with a reduced risk of dementia after stroke. Our findings support an association between moderate coffee and tea consumption and the risk of stroke and dementia. However, whether providing such information can improve the outcome of stroke and dementia remains to be determined.
STROBE, to strengthen the report of epidemiological observational research.
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(A) The association of coffee and tea with stroke and dementia. (B) The association between coffee and tea and post-stroke dementia.
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(A1) Coffee and stroke. (A2) Tea and stroke. (A3) The combination of coffee and tea during stroke. (B1) Coffee and dementia. (B2) Tea and dementia. (B3) Combination of coffee and tea to treat dementia. (C1) Coffee and post-stroke dementia. (C2) Tea and post-stroke dementia. (C3) The combination of coffee and tea treats post-stroke dementia. The 95% CI of the adjusted HR is represented by the shaded area. HR, risk ratio.
https://doi.org/10.1371/journal.pmed.1003830.s039
Note: Multivariate models are based on gender, age, race (white, Asian or Asian British, black or British black, and other races), qualifications (university or university degree, A level/AS level or equivalent, O level/GCSE Adjusted or equivalent, CSE or equivalent, NVQ or HND or HNC or equivalent, other professional qualifications, or none of the above), income (less than £18,000, 18,000 to 30,999, 31,000 to 51,999, 52,000 to 100,000, And greater than 0000), BMI (<25, 25 to <30, 30 to <35 and ≥35 kg/m2), smoking status (never, before and now), alcohol status (never, before and now), body Activities (low, medium, and high), diet patterns (healthy and unhealthy, produced by fruits, vegetables, fish, processed meats, unprocessed red meat, whole grains, and refined grains), consumption of sugary beverages, high-density lipoproteins , Low-density lipoprotein, cancer, diabetes, CAD and high blood pressure, we adjusted the coffee in the tea analysis or the tea in the coffee analysis. A. Senior; AS, senior subsidiary; BMI, body mass index; CAD, cardiovascular artery disease; CSE, certificate of secondary education; GCSE, general certificate of secondary education; HDL, high-density lipoprotein; HNC, national advanced certificate; HND, National Higher Diploma; HR, risk ratio; low-density lipoprotein, low-density lipoprotein; NVQ, national vocational qualification; oh, ordinary.
https://doi.org/10.1371/journal.pmed.1003830.s040
We thank the participants of the British Biobank. This research was carried out using the resources of the British Biobank, project number 45676.
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