Key points are not available for this paper at this time.
Background Tea consumption is inversely associated with cardiovascular risk in general populations, but evidence from patients with established coronary heart disease (CHD) is limited. Whether lipoprotein(a) Lp(a) and C-reactive protein (CRP) modify this association has not been examined. Methods From the UK Biobank, 25,306 participants with established CHD were identified (3,773 MACE events over a mean follow-up of 13.9 years). Cox regression with progressive adjustment was performed on 22,012 participants with complete covariate data. Restricted cubic splines (RCS), causal mediation analysis for Lp(a), and three-way interaction tests (tea × Lp(a) × CRP) were performed. A four-quadrant stratification by Lp(a) (cut-off 50 nmol/L) and CRP (cut-off 3 mg/L) was constructed. Results RCS analysis identified a non-linear dose–response relationship ( p 0.0001), with the lowest MACE risk at approximately 3 cups/day (HR 0.828, 95% CI 0.790–0.867, relative to 0 cups/day). Fully adjusted heavy tea consumption (≥4 cups/day) was associated with reduced risk (HR 0.895, p = 0.037). Lp(a) did not mediate the association (ACME p 0.05). A three-way interaction was suggested at the boundary of conventional significance ( p = 0.050): the low-Lp(a)/high-CRP subgroup showed the strongest benefit (HR 0.670, p 0.001), while the high-Lp(a)/high-CRP subgroup showed none (HR 0.992, p = 0.960). Conclusion In CHD patients, tea consumption of approximately 3 cups/day is associated with the lowest MACE risk. This association is jointly modified by the Lp(a)–CRP profile, with the greatest benefit in patients whose residual risk is predominantly inflammation-driven.
张春霞 (Thu,) studied this question.