Habitual tea consumption is associated with lower cardiovascular disease risk

Background Tea consumption has been associated with vascular health, but evidence regarding multidimensional tea‐drinking characteristics and their joint associations with other lifestyle factors remains limited. Objectives To examine associations of multidimensional tea‐drinking characteristics with vascular disease (VD) and assess joint associations and interactions with smoking and physical activity (PA). Methods We included 485,934 participants from the China Kadoorie Biobank (CKB). Multivariable Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for total VD and 12 subtypes. Dose–response relationships and joint associations and interactions of tea consumption with smoking and PA were evaluated. Results During a mean follow‐up of 9.05 years, 14,863 incident VD cases occurred. Habitual tea consumption was associated with lower total VD risk (HR = 0.888, 95%CI 0.857–0.921) and several major cardiovascular and cerebrovascular outcomes. Associations varied by tea‐drinking characteristics: Black tea showed more consistent inverse associations than green tea, moderate‐strength tea was associated with lower risk, whereas ‘burning hot’ tea was associated with higher VD risk (HR = 1.160, 95%CI 1.090–1.236). Tea intake showed non‐linear dose–response associations, with the lowest estimated risk at approximately 6–8 cups/day among weekly drinkers. The combination of habitual tea consumption, non‐smoking and high PA was associated with the lowest VD risk (HR = 0.548, 95%CI 0.492–0.609), with evidence of sub‐additive tea–PA interaction. Conclusion Habitual tea consumption was associated with lower VD risk, with associations varying by drinking characteristics and intake level. Tea consumption combined with non‐smoking and high PA was associated with the lowest risk. These findings support considering multidimensional tea‐drinking and lifestyle patterns in vascular health research.