Abstract
Background
Green tea and black tea have shown beneficial effects on cardiovascular health, and they are recommended for the prevention of cardiovascular disease (CVD) events. However, the impact of herbal tea on cardiovascular health remains unclear. This study aims to evaluate the potential benefits of herbal tea consumption in reducing the risk of incident CVD events in the general population.
Methods
Data for this study were derived from the Multi-Ethnic Study of Atherosclerosis (MESA). The primary outcome was incident CVD events, while secondary outcomes included all-cause and cardiovascular mortality. Cox proportional hazards regression models were used to examine the relationship between herbal tea consumption and the risk of incident CVD events. Kaplan-Meier survival curves were employed to assess the timing of incident CVD events, all-cause mortality and cardiovascular mortality.
Results
A total of 4711 participants were included in the analysis, with 1834 (38.9%) in the herbal tea group and 2877 (61.1%) in the control group. Over a median follow-up of 14.1 years, 547 participants (11.61%) experienced new-onset CVD events. The herbal tea group had a significantly lower incidence of new-onset CVD events (9.0% vs. 13.3%, p < 0.001), all-cause mortality (5.1% vs. 8.8%, p < 0.001), and cardiovascular mortality (1.4% vs. 2.5%, p = 0.01) compared to the control group. Multivariate Cox regression analysis revealed that herbal tea consumption was independently associated with a lower risk of incident CVD events [HR 0.83, 95% CI (0.69–0.997), p = 0.046] and all-cause mortality [HR 0.76, 95% CI (0.60–0.97), p = 0.03]. Kaplan-Meier analysis confirmed that participants in the herbal tea group had a significantly lower risk of incident CVD events, as well as lower all-cause and cardiovascular mortality. Secondary analyses indicated that moderate frequency herbal tea consumption (2 cups/month to 2 cups/week) and consistent consumption were associated with the most pronounced cardiovascular benefits.
Conclusions
This study demonstrated that herbal tea consumption was associated with a lower risk of incident CVD events, as well as reduced all-cause and cardiovascular mortality. These benefits were especially evident among individuals who consumed herbal tea at a moderate frequency and maintained consistent intake over time.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12937-025-01196-4.
Keywords: Herbal tea, Cardiovascular disease, MESA, Cardiovascular mortality, All-cause mortality
Introduction
Cardiovascular diseases (CVD) remain the leading cause of global mortality and a major contributor to disability, despite the widespread implementation of pharmacological and non-pharmacological strategies for prevention and treatment [1]. Upstream treatment and modification of cardiovascular risk factors are critical strategies for preventing CVD events [2]. Among the modifiable risk factors, dietary patterns are among the most important modifiable risk factors for CVD morbidity and mortality [3–6]. Healthy dietary patterns, such as the Mediterranean diet, and traditional Jiangnan diet, have been shown to reduce the risk of cardiovascular metabolic diseases and are recommended for the primary and secondary prevention of CVD [7–11]. These diets are rich in fruits, dietary fiber, and polyunsaturated fatty acids while limiting refined carbohydrates, saturated fats, salt, and sugar, thereby offering significant cardiovascular protective effects. The American Heart Association has emphasized the importance of dietary patterns in cardiovascular health, recommending diets rich in fruits and vegetables while avoiding beverages supplemented with added sugars [12]. In addition, reducing the intake of sugar-sweetened beverages and trans fats is also crucial for lowering the incidence and mortality of CVD, and these measures are widely endorsed in both primary and secondary prevention guidelines [11, 13]. Tea, prepared by steeping the leaves, flowers, roots, or other parts of specific plants, is the most popular beverage worldwide, second only to water [14]. It is free from added sugars and rich in bioactive compounds, potentially offering substantial cardiovascular benefits.
Green tea and black tea, derived from the leaves of Camellia sinensis (in its unoxidized and oxidized forms, respectively), are widely consumed across East Asia, Europe, and the Americas. Numerous studies have identified the cardiovascular benefits of both types of tea [15]. Notably, the Dutch dietary guidelines recommend consuming three cups of green or black tea daily to reduce CVD risk in the general population [16]. Herbal tea, another popular tea across Europe, Asia, and the Americas, contains no added sugars, sweeteners, or trans fats. As such, it is a beverage that theoretically help reduce the incidence and mortality of CVD. Preclinical studies have shown that certain constituents of herbal tea exert multiple biological effects, including antioxidant, anti-inflammatory, and immunomodulatory properties, as well as regulation of glucose and lipid metabolism [17–20]. Moreover, herbal teas have been used empirically in the prevention of cardiovascular and cerebrovascular diseases for thousands of years [21]. Despite these promising attributes, there remains a paucity of rigorous clinical research specifically evaluating the association between herbal tea consumption and cardiovascular outcomes. This highlights the need for further investigation to better understand its potential role in CVD prevention.
The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled 6,814 participants without a history of clinical CVD at baseline and completed a 10-year follow-up [22]. Dietary habits, including herbal tea consumption, were assessed for all participants, making MESA a robust cohort for evaluating the relationship between herbal tea intake and cardiovascular outcomes in the general population. We hypothesized that herbal tea consumption would be significantly associated with a lower risk of incident CVD events, as well as all-cause and cardiovascular mortality.
Methods
Study population
The MESA study enrolled 6,814 participants aged 45 to 84 years, all without a history of clinical CVD at baseline (July 2000 to August 2002, exam 1). Participants were recruited from six field centers across the United States: Baltimore City and Baltimore County (Maryland), Chicago (Illinois), Forsyth County (North Carolina), Los Angeles County (California), New York (New York), and St. Paul (Minnesota). At the first examination, demographic information, comorbidities, laboratory test results, and cardiac MRI data were collected from all participants. Following the initial examination, participants underwent five additional examinations: exam 2 (2002–2004), exam 3 (2004–2005), exam 4 (2005–2007), exam 5 (2010–2011), and exam 6 (2016–2018). In addition to the scheduled exams, participants were contacted every 9 to 12 months to assess and adjudicate clinical morbidity and mortality [22]. The study was conducted with the approval of the Institutional Review Boards at each participating site, and informed consent was obtained from all participants.
Definition of herbal tea consumption
At exam 1 and exam 5 of the MESA study, a 120-item food frequency questionnaire was used to assess participants’ dietary habits over the previous years. The majority of participants completed the questionnaire on their own with assistance from the certified clinic staff. The questionnaire included a wide range of dietary items such as staple foods, meats, vegetables, dairy products, fruits, sweets, specialty foods (Chinese food, Mexican food, and others), and beverages. Herbal tea was categorized as one of the beverages. The questionnaire primarily assessed herbal tea consumption by recording the frequency of intake, categorized as rare or never, 1 cup/month, 2–3 cups/month, 1 cup/week, 2cups/week, 3–4 cups/week, 5–6 cups/week, 1 cup/day and ≥ 2 cups/day. In addition, the questionnaire also surveyed the amount of herbal tea consumed by participants, categorized as small, moderate, and large amounts. Given the lack of a standardized criterion for estimating consumption volume among participants, the study primarily used consumption frequency to stratify the participants for analysis. Participants who reported never or rarely consuming herbal tea were classified as the control group, while those who consumed herbal tea ≥ 1 cup per month were assigned to the herbal tea group. Given that dietary habits may change over time, and that the questionnaire captures dietary patterns over the previous years, we used data from the exam 5 questionnaire to categorize participants into the control and herbal tea groups.
Study outcomes
The primary endpoint of the study was the incidence of new-onset CVD events during the follow-up period. CVD events included coronary heart disease (CHD), peripheral vascular disease, congestive heart failure, and cerebrovascular disease. CHD events encompassed acute myocardial infarction, cardiac arrest, angina pectoris, and CHD-related death. Congestive heart failure (HF) events included diagnoses made by a physician, medical treatments for HF, and pulmonary edema with left ventricular dysfunction. Cerebrovascular disease events included transient ischemic attacks and new-onset strokes [23, 24]. Secondary outcomes were all-cause mortality and cardiovascular mortality. The MESA study committee used standardized definitions to determine the cause of cardiovascular deaths. All-cause mortality was ascertained using city or state death records and included death from any cause. Cardiovascular mortality included death due to CHD, stroke, other atherosclerotic diseases, or other cardiovascular diseases [25].
To assess the incidence of new-onset CVD events, information was gathered from various sources, including public death records, hospital medical records, autopsy reports, and interviews with participants. In some cases, follow-up was supplemented by interviews or questionnaires from physicians, relatives, or friends.
Covariates
At the first exam, baseline data on demographics, smoking and alcohol history, and comorbid conditions were collected through a questionnaire. Age was categorized into 45–54, 55–64, 65–74, and 75–84 years. Race was classified as White Caucasian, Chinese-American, African-American, and Hispanic. Marital status was grouped into three categories: married or living as married; widowed, divorced, or separated; and never married or prefer not to answer. Education level was categorized as: no schooling; less than high school; high school or technical school; and higher than an associate degree. Smoking was defined as having smoked at least 100 cigarettes in one’s lifetime. Participants with smoking were then categorized as former smokers or current smokers based on their smoking status at the time of completing the food frequency questionnaire. Alcohol use was defined as having ever consumed alcoholic beverages. Participants who reported alcohol use were further classified as former drinkers or current drinkers. Hypertension was defined as a systolic blood pressure ≥ 140 mmHg, a diastolic blood pressure ≥ 90 mmHg, or current treatment with antihypertensive medications [26]. Diabetes was defined as a history of diabetes, treatment with antidiabetic medications, or a fasting blood glucose level ≥ 7 mmol/L. Impaired fasting glucose was defined as a fasting blood glucose level between 5.6 and 7.0 mmol/L [27]. Left ventricular ejection fraction were measured on cardiac MRI. Physical activity was assessed for all participants based on total weekly exercise time derived from questionnaire data, while stress levels were evaluated using Spielberger scales for anger, anxiety, and depression.
Statistical analysis
Continuous variables are presented as mean ± standard deviation (SD) or median (25th, 75th percentile), depending on data distribution, and were compared using either the t-test or the Mann-Whitney U test. Categorical variables are expressed as percentages and were compared using the χ² test or Fisher’s exact test, as appropriate. For missing baseline data, imputation using the respective mean values was performed. Univariate and multivariate Cox hazard regression analyses were conducted to identify potential predictors of incident CVD events, all-cause death, and cardiovascular death. Variables with a significance level of < 0.05 in the univariate Cox regression analysis were included in the multivariate model.
The Kaplan-Meier survival curve, alongside the Log-Rank test, was used to assess the timing of incident CVD events, all-cause mortality, and cardiovascular mortality, comparing participants with and without herbal tea consumption during follow-up. Subgroup analyses were performed by age, sex, body mass index, ethnicity, hypertension, and diabetes status.
Results
Baseline characteristics of enrolled participants
Of the 6814 participants enrolled at baseline, 4716 participants returned for the exam 5. After excluding participants without follow-up data (n = 5), a total of 4711 participants were included in the analysis. These participants were divided into the herbal tea group (n = 1834, 38.9%) and the control group (n = 2877, 61.1%) based on the food frequency questionnaire administered at exam 5 (Additional file 1: Figure S1). Compared to the control group, participants in the herbal tea group were younger [58 (51, 66) vs. 61 (53, 69) years, p < 0.001], had a lower proportion of males (36.8% vs. 53.0%, p < 0.001), and were less likely to be White Caucasian (35.8% vs. 44.0%, p < 0.001), married (60.0% vs. 65.8%, p < 0.001), smokers (45.5% vs. 50.9%, p < 0.001), and to have hypertension (38.9% vs. 42.5%, p = 0.01) or abnormal glucose levels (20.9% vs. 24.6%, p = 0.001). Conversely, the herbal tea group exhibited a higher prevalence of high education levels (48.8% vs. 41.5%, p < 0.001) and alcohol use (82.0% vs. 79.3%, p = 0.01). Additionally, the herbal tea group had lower levels of triglycerides [108 (76, 155) vs. 113 (78, 164) mg/dL, p = 0.01], glucose [88 (82, 96) vs. 90 (83, 99) mg/dL, p < 0.001], and serum creatinine [0.9 (0.8, 1.0) vs. 0.9 (0.8, 1.1) mg/dL, p < 0.001]. They also had higher levels of HDL cholesterol [50 (42, 61) vs. 48 (40, 58) mg/dL, p < 0.001] and physical activity [12.8 (10.0, 16.2) vs. 11.9 (9.1, 15.3) min/week, p < 0.001] (Table 1).
Table 1.
Baseline characteristics of enrolled participants
| Variables | Control group (n = 2877, 61.1%) |
Herbal tea group (n = 1834, 38.9%) |
P value |
|---|---|---|---|
| Age, years old | 61 (53, 69) | 58 (51, 66) | < 0.001 |
| Age categories, n (%) | < 0.001 | ||
| 45–54 years old | 850 (29.5) | 701 (38.2) | |
| 55–64 years old | 858 (29.8) | 579 (31.6) | |
| 65–74 years old | 878 (30.5) | 444(24.2) | |
| ≥75 years old | 291 (10.1) | 110 (6.0) | |
| Gender, n (%) | < 0.001 | ||
| Female | 1353 (47.0) | 1159 (63.2) | |
| Male | 1524 (53.0) | 675 (36.8) | |
| Ethnicity, n (%) | < 0.001 | ||
| White Caucasian | 1267 (44.0) | 656 (35.8) | |
| Chinese-American | 402 (14.0) | 139 (7.6) | |
| African-American | 667 (23.2) | 582 (31.7) | |
| Hispanic | 541 (18.8) | 457 (24.9) | |
| Marital status | < 0.001 | ||
| Married | 1893 (65.8) | 1100 (60.0) | |
| Widow, divorced, or separated | 750 (26.1) | 532 (29) | |
| Never married or no response | 234 (8.1) | 202 (11) | |
| Education | < 0.001 | ||
| No schooling | 25 (0.9) | 11 (0.6) | |
| Less than high school | 429 (14.9) | 216 (11.8) | |
| High school or technical school | 1229 (42.7) | 712 (38.8) | |
| Higher than an associate degree | 1194 (41.5) | 895 (48.8) | |
| BMI (Kg/m2) | 27.5 (24.5, 31.0) | 27.7 (24.6, 31.3) | 0.24 |
| Smoking, n (%) | < 0.001 | ||
| Never smokers, n (%) | 1414 (49.1) | 999 (54.5) | |
| Former smokers, n (%) | 1072 (37.3) | 656 (35.8) | |
| Current smokers, n (%) | 391 (13.6) | 179 (9.8) | |
| Alcohol use, n (%) | 0.01 | ||
| Never drinkers, n (%) | 596 (20.7) | 331 (18.0) | |
| Former drinkers, n (%) | 634 (22.0) | 377 (20.6) | |
| Current drinkers, n (%) | 1647 (57.2) | 1126 (61.4) | |
| Physical activity, min/W | 11.9 (9.1, 15.3) | 12.8 (10.0, 16.2) | < 0.001 |
| Spielberger anger score | 14 (12, 17) | 14 (12, 17) | 0.35 |
| Spielberger anxiety score | 15 (12, 19) | 15 (12, 19) | 0.85 |
| Spielberger depression score | 5 (2, 10) | 6 (2, 10) | 0.006 |
| Hypertension, n (%) | 1224 (42.5) | 713 (38.9) | 0.01 |
| Diabetes, n (%) | 0.001 | ||
| Normal fasting glucose | 2169 (75.4) | 1451 (79.1) | |
| Impaired fasting glucose | 386 (13.4) | 213 (11.6) | |
| Untreated diabetes | 54 (1.9) | 46 (2.5) | |
| Treated diabetes | 268 (9.3) | 124 (6.8) | |
| LV hypertrophy, n (%) | 86 (3.0) | 51 (2.8) | 0.74 |
| Triglycerides (mg/dl) | 113 (78, 164) | 108 (76, 155) | 0.01 |
| Glucose (mg/dL) | 90 (83, 99) | 88 (82, 96) | < 0.001 |
| LDL cholesterol (mg/dL) | 117 (96, 135) | 117 (97, 136) | 0.56 |
| HDL cholesterol (mg/dL) | 48 (40, 58) | 50 (42, 61) | < 0.001 |
| Total Cholesterol (mg/dL) | 192 (170, 215) | 194 (172, 216) | 0.13 |
| Creatinine (mg/dl) | 0.9 (0.8, 1.1) | 0.9 (0.8, 1.0) | < 0.001 |
| LV ejection fraction (%) | 69.0 (66.5, 72.5) | 69.0 (66.8, 72.7) | 0.31 |
BMI Body mass index, LV Left ventricular, LDL Low density lipoprotein, HDL High density lipoprotein
Herbal tea consumption is associated with lower risk of incident CVD events, all-cause mortality and cardiovascular mortality
Over an average follow-up of 14.1 years, 547 participants (11.61%) experienced new-onset CVD events. Compared to the control group, the herbal tea group exhibited a significantly lower incidence of new cardiovascular events (9.0% vs. 13.3%, p < 0.001). This was primarily driven by a reduced incidence of new-onset CHD (5.8% vs. 9.3%, p < 0.001) and HF (2.3% vs. 4.7%, p < 0.001). No significant differences were observed between the two groups in terms of cerebrovascular diseases or peripheral artery disease. During the follow-up period, a total of 346 participants (7.34%) died, of which 99 (2.10%) deaths were attributed to cardiovascular diseases. The herbal tea group demonstrated significantly lower all-cause mortality (5.1% vs. 8.8%, p < 0.001) and cardiovascular mortality (1.4% vs. 2.5%, p = 0.01) compared to the control group (Table 2).
Table 2.
Incidences of endpoints during follow-up
| Endpoints | Control group (n = 2877, 61.1%) |
Herbal tea group (n = 1834, 38.9%) |
P value |
|---|---|---|---|
| Cardiovascular disease, n (%) | 382 (13.3) | 165 (9.0) | < 0.001 |
| Coronary heart disease, n (%) | 267 (9.3) | 106 (5.8) | < 0.001 |
| Angina pectoris, n (%) | 179 (6.2) | 79 (4.3) | 0.006 |
| Myocardial infarction, n (%) | 129 (4.5) | 48 (2.6) | 0.001 |
| Coronary Revascularization, n (%) | 204 (7.1) | 79 (4.3) | < 0.001 |
| Congestive heart failure, n (%) | 134 (4.7) | 43(2.3) | < 0.001 |
| Peripheral vascular disease, n (%) | 52 (1.8) | 26 (1.4) | 0.37 |
| Stroke, n (%) | 116 (4.0) | 58 (3.2) | 0.14 |
| Transient ischemic attack, n (%) | 43 (1.5) | 22 (1.2) | 0.47 |
| All cause death, n (%) | 253 (8.8) | 93 (5.1) | < 0.001 |
| Cardiovascular death, n (%) | 73 (2.5) | 26 (1.4) | 0.01 |
Univariate Cox regression analysis showed that herbal tea consumption was associated with the incidence of new-onset CVD events [hazard ratio (HR) 0.65, 95% CI (0.54–0.78), p < 0.001], as well as age categories [HR 1.65, 95% CI (1.52–1.80), p < 0.001], hypertension [HR 2.41, 95% CI (2.03–2.86), p < 0.001], smoking [HR 1.25, 95% CI (1.12–1.41), p < 0.001], male sex [HR 1.89, 95% CI (1.59–2.24), p < 0.001], HDL cholesterol [HR 0.98, 95% CI (0.97–0.98), p < 0.001], triglycerides [HR 1.002, 95% CI (1.001–1.002), p < 0.001], diabetes [HR 1.40, 95% CI (1.30–1.51), p < 0.001], fasting glucose [HR 1.008, 95% CI (1.006–1.010), p < 0.001], left ventricular ejection fraction [HR 0.98, 95% CI (0.97-1.00), p = 0.01], physical activity [HR 0.98, 95% CI (0.97–0.997), p = 0.02], serum creatinine level [HR 2.40, 95% CI (1.82–3.17), p < 0.001], Spielberger anger score [HR 0.97, 95% CI (0.95–0.999), p < 0.001], and body mass index [HR 1.02, 95% CI (1.00-1.03), p = 0.03] (Table 3). After adjusting for these factors, multivariate Cox regression analysis confirmed that herbal tea consumption remained independently associated with a reduced risk of incident CVD events [HR 0.83, 95% CI (0.69–0.997), p = 0.046] (Table 3). Kaplan-Meier analysis indicated that participants in the herbal tea group had a significantly lower risk of incident CVD events during follow-up (Fig. 1A).
Table 3.
Univariable and multivariable associations between baseline characteristics and incident CVD events during follow-up
| Variables | Univariate regression analysis | Multivariate regression analysis | ||||
|---|---|---|---|---|---|---|
| HR | 95% CI | p value | HR | 95% CI | p value | |
| Herbal tea consumption | 0.65 | 0.54–0.78 | < 0.001 | 0.83 | 0.69–0.997 | 0.046 |
| Age categories | 1.65 | 1.52–1.80 | < 0.001 | 1.59 | 1.44–1.75 | < 0.001 |
| Hypertension | 2.41 | 2.03–2.86 | < 0.001 | 1.82 | 1.51–2.19 | < 0.001 |
| Smoking | 1.25 | 1.12–1.41 | < 0.001 | 1.25 | 1.11–1.42 | < 0.001 |
| Male sex | 1.89 | 1.59–2.24 | < 0.001 | 1.46 | 1.17–1.82 | < 0.001 |
| HDL cholesterol (mg/dl) | 0.98 | 0.97–0.98 | < 0.001 | 0.99 | 0.98–0.996 | 0.003 |
| Triglycerides (mg/dl) | 1.002 | 1.001–1.002 | < 0.001 | 1.001 | 1.00-1.002 | 0.008 |
| Diabetes | 1.40 | 1.30–1.51 | < 0.001 | 1.12 | 1.01–1.25 | 0.03 |
| Fasting glucose (mg/dl) | 1.008 | 1.006–1.010 | < 0.001 | 1.004 | 1.00–1.01 | 0.049 |
| LV ejection fraction (%) | 0.98 | 0.97-1.00 | 0.01 | 0.99 | 0.98–1.00 | 0.13 |
| Physical activity | 0.98 | 0.97–0.997 | 0.02 | 1.01 | 0.995–1.02 | 0.19 |
| Creatinine (mg/dl) | 2.40 | 1.82–3.17 | < 0.001 | 1.07 | 0.72–1.58 | 0.75 |
| Spielberger anger score | 0.97 | 0.95–0.999 | 0.04 | 0.998 | 0.97–1.02 | 0.86 |
| BMI (Kg/m2) | 1.02 | 1.00-1.03 | 0.03 | 1.00 | 0.98–1.02 | 0.90 |
CVD Cardiovascular disease, HR Hazard ratio, CI Confidence interval, HDL High density lipoprotein, LV Left ventricular, BMI Body mass index
Fig. 1.
Kaplan-Meier analysis of the cumulative incidence of new-onset CVD events (A), all-cause mortality (B), and cardiovascular mortality (C) between the herbal tea group and the control group during the follow-up period CVD, cardiovascular disease
Additionally, univariate Cox regression analysis revealed that herbal tea consumption was associated with reduced all-cause mortality [HR 0.56, 95% CI (0.44–0.71), p < 0.001] and cardiovascular mortality [HR 0.54, 95% CI (0.45–0.85), p = 0.008] during follow-up (Additional file 1:Table S1 and Table S2).After adjusting for other factors associated with all-cause mortality, multivariate Cox regression analysis showed that herbal tea consumption remained independently associated with a reduced risk of all-cause mortality [HR 0.76, 95% CI (0.60–0.97), p = 0.03] (Additional file 1:Table S1). However, multivariate analysis showed that herbal tea consumption was not significantly associated with lower cardiovascular mortality after adjusting for other factors [HR 0.72, 95% CI (0.46–1.14), p = 0.16] (Additional file 1: Table S2). Kaplan-Meier analysis demonstrated that participants in the herbal tea group had a significantly lower risk of both all-cause mortality and cardiovascular mortality (Fig. 1B and C).
Subgroup analysis and secondary analysis
Stratified analyses by age, BMI, sex, ethnicity, hypertension, and diabetes were performed to evaluate the protective effect of herbal tea on incident CVD events in specific subgroups. The results showed that the protective effect was not statistically significant among male participants (HR: 0.86, 95% CI: 0.68–1.09, p = 0.21) and participants with diabetes (HR: 0.85, 95% CI: 0.63–1.15, p = 0.29) (Fig. 2), suggesting that male sex and diabetes may attenuate the potential benefits of herbal tea consumption. However, in all other subgroups, herbal tea consumption was associated with a significantly reduced risk of CVD events (HR < 1.0, p < 0.05) (Fig. 2). These findings support a generally consistent protective effect of herbal tea on incident CVD across most subpopulations.
Fig. 2.
Subgroup analysis of the association between herbal tea consumption and the incidence of new-onset CVD events in the MESA study BMI, body mass index; CVD, cardiovascular disease; HR, hazard ratio; CI, confidence interval; MESA, Multi-Ethnic Study of Atherosclerosis
In the secondary analysis, the relationship between the frequency of herbal tea consumption and the 10-year incidence of new-onset CVD was firstly explored. The results showed that, compared to individuals without herbal tea consumption, any frequency of herbal tea consumption was associated with a reduced risk of incident CVD events, all-cause mortality, and cardiovascular mortality (Additional file 1: Figure S2). Furthermore, individuals who consumed 2 cups per month to 2 cups per week had the lowest risk of developing CVD (Additional file 1: Figure S2). Based on the relationship between herbal tea consumption frequency and the risk of incident CVD, as well as grouping criteria from previous studies [28], the study population was then divided into 4 groups based on the frequency of herbal tea consumption: non-consumers (n = 2877), mild frequency consumers (1 cup/month, n = 638), moderate frequency consumers (2 cups/month − 2 cups/week, n = 825), and high frequency consumers (≥ 3 cups/week, n = 371). The results showed that moderate frequency herbal tea consumption was independently associated with a lower risk of incident CVD events. However, it was not significantly associated with all-cause mortality or cardiovascular mortality (Table 4). Further, we divided the study cohort based on herbal tea consumption at both exam 1 and exam 5 into four groups: Group 1 (no herbal tea consumption at either exam, n = 2018), Group 2 (herbal tea consumed at exam 1 but not at exam 5, n = 619), Group 3 (no herbal tea consumed at exam 1 but consumed at exam 5, n = 543), and Group 4 (herbal tea consumed at both exam 1 and exam 5, n = 1122). The results demonstrated that participants in Group 4 had the lowest risk of incident CVD events, all-cause mortality, and cardiovascular mortality (Additional file 1: Figure S3).
Table 4.
Secondary analysis between herbal tea amount and incident CVD events, all-cause mortality, and cardiovascular mortality
| Group | n | Incidence (%) | HR 95%CI | p value | Adjusted HR 95%CI | p value |
|---|---|---|---|---|---|---|
| Incident CVD | ||||||
| Non-consumers | 2877 | 13.3 | 1.0 (reference) | 1.0 (reference) | ||
| Mild consumers | 638 | 11.3 | 0.83 (0.64–1.07) | 0.14 | 1.05 (0.81–1.35) | 0.71 |
| Moderate consumers | 825 | 7.2 | 0.51 (0.39–0.68) | < 0.001 | 0.66 (0.50–0.87) | 0.003 |
| High consumers | 371 | 9.2 | 0.66 (0.47–0.94) | 0.02 | 0.82 (0.57–1.16) | 0.26 |
| All cause death | ||||||
| Non-consumers | 2877 | 8.8 | 1.0 (reference) | 1.0 (reference) | ||
| Mild consumers | 638 | 4.2 | 0.46 (0.31–0.69) | < 0.001 | 0.65 (0.44–0.97) | 0.03 |
| Moderate consumers | 825 | 5.8 | 0.65 (0.47–0.88) | 0.006 | 0.89 (0.65–1.21) | 0.46 |
| High consumers | 371 | 4.9 | 0.53 (0.33–0.86) | 0.009 | 0.68 (0.42–1.10) | 0.12 |
| CVD death | ||||||
| Non-consumers | 2877 | 2.5 | 1.0 (reference) | 1.0 (reference) | ||
| Mild consumers | 638 | 1.1 | 0.42 (0.19–0.91) | 0.03 | 0.62 (0.28–1.35) | 0.23 |
| Moderate consumers | 825 | 1.6 | 0.61 (0.34–1.10) | 0.10 | 0.85 (0.47–1.54) | 0.59 |
| High consumers | 371 | 1.6 | 0.62 (0.27–1.42) | 0.25 | 0.77 (0.34–1.79) | 0.45 |
Mild consumers: 1 cup/month
Moderate consumers: 2 cups/month-2 cups/week
High consumers: ≥ 3 cups/week
Adjust for other risk factors identified in the univariate Cox regression analysis
Discussion
This study is the first to investigate the effects of herbal tea consumption on cardiovascular health in the general population. The results showed that participants who consumed herbal tea had a lower risk of incident CVD events, all-cause mortality, and cardiovascular mortality, even after adjusting for demographic factors, lifestyle habits, hypertension, and other cardiovascular risk factors. The secondary analysis revealed that moderate frequency herbal tea consumption (2 cups/month to 2 cups/week) and consistent consumption over time were associated with more pronounced beneficial effects.
The results of the present study were derived from the MESA study, a well-established multi-center cohort study, which enhanced the reliability and generalizability of our findings. With comprehensive follow-up and a diverse population that includes White, Chinese-American, African-American, and Hispanic participants, the MESA study ensures broad applicability of the results to various demographic groups [22, 23]. Importantly, all participants were free from CVD at baseline, which reduces the likelihood of lifestyle changes influenced by health concerns and minimizes potential confounding factors [22, 28].
The beneficial effects of herbal tea on the cardiovascular system may be attributed to its diverse biological actions. Key risk factors for atherosclerosis and coronary heart disease, such as dysregulated glucose and lipid metabolism, along with hypertension, have been shown to improve with herbal tea consumption. Previous studies suggest that herbal tea can positively influence glucose and lipid metabolism and may exert antihypertensive effects, contributing to a reduction in CVD risk [29–33]. Therefore, long-term consumption of herbal tea could potentially reduce CVD risk by modulating glucose and lipid metabolism as well as controlling hypertension in individuals. Inflammation is a hallmark of CVD and plays a crucial role in the onset and progression of these conditions [34]. Studies indicated that various herbal teas could modulate macrophage polarization, inhibit cytokine production and secretion, and reduce inflammatory cell infiltration by maintaining vascular permeability [35, 36]. These anti-inflammatory effects may represent one of the key mechanisms through which herbal tea lowers CVD risk. Additionally, herbal tea has been shown to regulate oxidative stress [37], apoptosis [19], pyroptosis [38], autophagy and maintaining cellular homeostasis [39], which are closely linked to the initiation and progression of CVD [40]. However, while these mechanisms are supported by biological evidence, direct clinical evidence confirming the cardiovascular protective effects of herbal tea is still lacking. The results of our study demonstrated that herbal tea consumption was associated with a reduced risk of incident CVD events, all-cause mortality, and cardiovascular mortality, providing clinical evidence supporting its potential cardioprotective effects.
A more in-depth analysis of the protective effects of herbal tea on the incidence of CVD events revealed that it significantly reduced the risk of coronary heart disease and heart failure. However, the study did not show a significant protective effect against peripheral vascular diseases or cerebrovascular diseases. This lack of association may be attributed to the different pathophysiological mechanisms that underlie these diseases compared to coronary heart disease and heart failure. Interestingly, prior animal studies have demonstrated that certain components found in herbal teas can help reduce infarct size and promote recovery after cerebral infarction. These studies suggest that herbal tea may have neuroprotective effects, potentially improving post-stroke recovery and limiting the extent of cerebral damage [41, 42]. However, the discrepancy between these promising animal model results and the lack of a significant protective effect observed in human studies warrants further investigation. Another finding of our study was that only moderate frequency consumption of herbal tea was associated with a significant reduction in CVD events. One possible explanation was that moderate consumption might provide sufficient bioactive compounds to exert cardiovascular benefits, while avoiding potential negative effects that may occur with excessive consumption [43–46]. However, the exact mechanism is not fully understood, and further research is needed to explore the optimal frequency of herbal tea consumption for cardiovascular health.
This study suggests that herbal tea has protective effects on the cardiovascular system, but several issues remain unresolved. First, there is considerable variability in herbal tea formulations, and it remains unclear whether all varieties confer cardiovascular benefits. Future studies should distinguish among different types of herbal teas to better elucidate their cardioprotective effects. Second, the specific bioactive components and mechanisms responsible for these effects are not yet fully understood, and identifying the precise molecular pathways is crucial. Additionally, our study demonstrated that participants who consistently consumed herbal tea over time had the lowest risk of incident CVD, all-cause and cardiovascular mortality. However, only 1,834 participants (61.2%) in the herbal tea group consistently consumed herbal tea, which might reduce cardioprotective effects of herbal tea. Moreover, concerns remain regarding the long-term safety of herbal tea consumption. Several studies have suggested that long-term herbal tea consumption could lead to serious complications, such as hypertension, electrolyte imbalances, cerebrovascular spasms, atrioventricular conduction block, and even sudden death [43–46]. Lastly, the beneficial effect of herbal tea on cardiovascular mortality was not statistically significant in the multivariable Cox regression analysis. We speculated that this might be attributed to the low incidence of cardiovascular mortality in the study population, as only 99 participants died from CVD-related causes. The limited number of events may have reduced the statistical power to detect a significant association.
Conclusions
This study demonstrated that herbal tea consumption was associated with a lower risk of incident cardiovascular disease events, as well as reduced all-cause and cardiovascular mortality. These benefits were especially evident among individuals who consumed herbal tea at a moderate frequency (2 cups/month − 2 cups/week) and maintained consistent intake over time.
Supplementary Information
Acknowledgements
We thank all researchers and participants of the MESA study.
Abbreviations
- CVD
Cardiovascular disease
- MESA
Multi-Ethnic Study of Atherosclerosis
- CHD
Coronary heart disease
- HF
Heart failure
- HR
Hazard ratio
Authors’ contributions
Conceptualization: BZ, SF and BY. Methodology: BZ, WT and YW. Investigation: BZ, and WT; Software: BZ and WT. Writing – Original Draft: BZ and WT. Writing – Review & Editing: SF and BY. Resources: SF and BY. Funding acquisition: BY. Supervision: SF, YW and BY. All authors reviewed the manuscript.
Funding
This work was supported by the Key Specialty Construction Project of Shanghai Pudong New Area Health Commission (NO.PWZzk2022-03), Shanghai Municipal Health Commission (NO.202340214), National Natural Science Foundation of China (NO.82370323).
Data availability
Data from the Multi-Ethnic Study of Atherosclerosis (MESA) study can be requested through the National Institutes of Health’s Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) open program, accessible at https://biolincc.nhlbi.nih.gov/studies/mesa/.
Declarations
Ethics approval and consent to participate
The study was conducted with the approval of the Institutional Review Boards at each participating site, and informed consent was obtained from all participants.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Baowei Zhang and Wenjuan Tang contributed equally as first authors.
Contributor Information
Songtao Feng, Email: fengsongtao@126.com.
Bing Yang, Email: bingyang@tongji.edu.cn.
References
- 1.Vaduganathan M, Mensah GA, Turco JV, Fuster V, Roth GA. The global burden of cardiovascular diseases and risk: a compass for future health. J Am Coll Cardiol. 2022;80(25):2361–71. [DOI] [PubMed] [Google Scholar]
- 2.McClellan M, Brown N, Califf RM, Warner JJ. Call to action: urgent challenges in cardiovascular disease: A presidential advisory from the American Heart Association. Circulation. 2019;139(9):e44-54. [DOI] [PubMed] [Google Scholar]
- 3.Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet. 2020;395(10226):795–808. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Li S, Liu Z, Joseph P, Hu B, Yin L, Tse LA, et al. Modifiable risk factors associated with cardiovascular disease and mortality in China: a PURE substudy. Eur Heart J. 2022;43(30):2852–63. [DOI] [PubMed] [Google Scholar]
- 5.Micha R, Penalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA. 2017;317(9):912–24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Budhathoki S, Sawada N, Iwasaki M, Yamaji T, Goto A, Kotemori A, et al. Association of animal and plant protein intake with all-cause and cause-specific mortality in a Japanese cohort. JAMA Intern Med. 2019;179(11):1509–18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Glenn AJ, Guasch-Ferre M, Malik VS, Kendall CWC, Manson JE, Rimm EB, et al. Portfolio diet score and risk of cardiovascular disease: findings from 3 prospective cohort studies. Circulation. 2023;148(22):1750–63. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Laguzzi F, Akesson A, Marklund M, Qian F, Gigante B, Bartz TM, et al. Role of polyunsaturated fat in modifying cardiovascular risk associated with family history of cardiovascular disease: pooled de novo results from 15 observational studies. Circulation. 2024;149(4):305–16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Luo Y, Wang J, Sun L, Gu W, Zong G, Song B, et al. Isocaloric-restricted Mediterranean diet and Chinese diets high or low in plants in adults with prediabetes. J Clin Endocrinol Metab. 2022;107(8):2216–27. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Pagidipati NJ, Taub PR, Ostfeld RJ, Kirkpatrick CF. Dietary patterns to promote cardiometabolic health. Nat Rev Cardiol. 2025;22(1):38–46. [DOI] [PubMed] [Google Scholar]
- 11.Writing Committee Members, Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: A report of the American heart association/american college of cardiology joint committee on clinical practice guidelines. J Am Coll Cardiol. 2023;82(9):833–955. [DOI] [PubMed] [Google Scholar]
- 12.Lichtenstein AH, Appel LJ, Vadiveloo M, Hu FB, Kris-Etherton PM, Rebholz CM, et al. 2021 dietary guidance to improve cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2021;144(23):e472-87. [DOI] [PubMed] [Google Scholar]
- 13.Lara-Castor L, O’Hearn M, Cudhea F, Miller V, Shi P, Zhang J, et al. Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries. Nat Med. 2025. 10.1038/s41591-024-03345-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Brody H, Tea. Nature. 2019;566(7742):S1. [DOI] [PubMed] [Google Scholar]
- 15.Abe SK, Inoue M. Green tea and cancer and cardiometabolic diseases: a review of the current epidemiological evidence. Eur J Clin Nutr. 2021;75(6):865–76. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Kromhout D, Spaaij CJ, de Goede J, Weggemans RM. The 2015 Dutch food-based dietary guidelines. Eur J Clin Nutr. 2016;70(8):869–78. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Mohammed SH, Shakor JK, Salih M, Khafar K, Ali HM, Baqi HR, et al. A comparative effect of different herbal products on lipid metabolism and hepatic tissue: an experimental study on a rat model. Cureus. 2024;16(11):e73799. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Bai Y, Zhang X, Wang F, Li Y, Guo S, Feng J, et al. Exploring the potential mechanisms of Zhu-ye-qing wine in preventing cardiovascular and cerebrovascular diseases based on network pharmacology. Crit Rev Biomed Eng. 2024;52(6):15–31. [DOI] [PubMed] [Google Scholar]
- 19.Kao SW, Chang YC, Lin FH, Huang TL, Chen TS, Lin SZ, et al. Jing-si herbal tea suppresses H(2)O(2) -instigated inflammation and apoptosis by inhibiting Bax and mitochondrial cytochrome C release in HIG-82 synoviocytes. Environ Toxicol. 2024;39(12):5347–56. [DOI] [PubMed] [Google Scholar]
- 20.Abubakar AS, Ahmad B, Ahmad N, Liu L, Liu B, Qu Y, et al. Physicochemical evaluation, structural characterization, in vitro and in vivo bioactivities of water-soluble polysaccharides from Luobuma (Apocynum L.) tea. Food Chem. 2024;460(Pt 2):140453. [DOI] [PubMed] [Google Scholar]
- 21.Poswal FS, Russell G, Mackonochie M, MacLennan E, Adukwu EC, Rolfe V. Herbal teas and their health benefits: a scoping review. Plant Foods Hum Nutr. 2019;74(3):266–76. [DOI] [PubMed] [Google Scholar]
- 22.Bild DE, Bluemke DA, Burke GL, Detrano R, Diez Roux AV, Folsom AR, et al. Multi-Ethnic study of atherosclerosis: objectives and design. Am J Epidemiol. 2002;156(9):871–81. [DOI] [PubMed] [Google Scholar]
- 23.Kawel-Boehm N, Kronmal R, Eng J, Folsom A, Burke G, Carr JJ, et al. Left ventricular mass at MRI and long-term risk of cardiovascular events: the Multi-Ethnic study of atherosclerosis (MESA). Radiology. 2019;293(1):107–14. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Bluemke DA, Kronmal RA, Lima JA, Liu K, Olson J, Burke GL, et al. The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic study of Atherosclerosis) study. J Am Coll Cardiol. 2008;52(25):2148–55. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Lawrence WR, Jones GS, Johnson JA, Ferrell KP, Johnson JN, Shiels MS, et al. Discrimination experiences and all-cause and cardiovascular mortality: multi-ethnic study of atherosclerosis. Circ Cardiovasc Qual Outcomes. 2023;16(4): e009697. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45(38):3912–4018. [DOI] [PubMed] [Google Scholar]
- 27.American Diabetes Association Professional Practice C. 2. Diagnosis and classification of diabetes: standards of care in Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S20–42. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Sehrawat O, Mehra NS, Kowlgi NG, Hodge DO, Lee JZ, Egbe AC, et al. Association between coffee consumption and incident atrial fibrillation (from the Multi-Ethnic study of atherosclerosis [MESA]). Am J Cardiol. 2023;186:5–10. [DOI] [PubMed] [Google Scholar]
- 29.Roghani-Shahraki H, Karimian M, Valipour S, Behjati M, Arefnezhad R, Mousavi A. Herbal therapy as a promising approach for regulation on lipid profiles: a review of molecular aspects. J Cell Physiol. 2021;236(8):5533–46. [DOI] [PubMed] [Google Scholar]
- 30.Chbili C, Maoua M, Selmi M, Mrad S, Khairi H, Limem K, et al. Evaluation of daily Laurus nobilis tea consumption on lipid profile biomarkers in healthy volunteers. J Am Coll Nutr. 2020;39(8):733–8. [DOI] [PubMed] [Google Scholar]
- 31.Wang P, Ma XM, Geng K, Jiang ZZ, Yan PY, Xu Y. Effects of camellia tea and herbal tea on cardiometabolic risk in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Phytother Res. 2022;36(11):4051–62. [DOI] [PubMed] [Google Scholar]
- 32.Kheirkhah J, Ghorbani Z, Salari A, Mahdavi-Roshan M, Gholipour M, Vakilpour A, et al. Melissa officinalis tea favourably affects the frequency of premature ventricular beats and cardiometabolic profile among patients with premature ventricular contraction: a randomised open-label controlled trial. Int J Clin Pract. 2021;75(10): e14644. [DOI] [PubMed] [Google Scholar]
- 33.Zhang X, Zhang L, Zhang B, Liu K, Sun J, Li Q, et al. Herbal tea, a novel adjuvant therapy for treating type 2 diabetes mellitus: a review. Front Pharmacol. 2022;13:982387. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Liberale L, Badimon L, Montecucco F, Luscher TF, Libby P, Camici GG. Inflammation, aging, and cardiovascular disease: JACC review topic of the week. J Am Coll Cardiol. 2022;79(8):837–47. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Chiang CY, Lin YJ, Weng WT, Lin HD, Lu CY, Chen WJ, et al. Recuperative herbal formula Jing Si maintains vasculature permeability balance, regulates inflammation and assuages concomitants of long-covid. Biomed Pharmacother. 2023;163: 114752. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Wei MJ, Huang KL, Kang HF, Liu GT, Kuo CY, Tzeng IS, et al. Jing Si herbal tea modulates macrophage polarization and inflammatory signaling in LPS-Induced inflammation. Int J Med Sci. 2024;21(15):3046–57. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Lai KH, Chen YL, Lin MF, El-Shazly M, Chang YC, Chen PJ, et al. Lonicerae japonicae flos attenuates neutrophilic inflammation by inhibiting oxidative stress. Antioxidants. 2022;11(9):1781. 10.3390/antiox11091781. [DOI] [PMC free article] [PubMed]
- 38.Jiang X, Sun J, Guo S, Zhao Z, Chen Y, Cao J, et al. Elsholtzia bodinieri Vaniot ameliorated acute lung injury in mice by regulating pyroptosis, inflammation, oxidative stress and macrophage polarization. J Ethnopharmacol. 2023;307: 116232. [DOI] [PubMed] [Google Scholar]
- 39.Brimson JM, Prasanth MI, Malar DS, Sharika R, Sivamaruthi BS, Kesika P, et al. Role of herbal teas in regulating cellular homeostasis and autophagy and their implications in regulating overall health. Nutrients. 2021;13(7):2162. 10.3390/nu13072162. [DOI] [PMC free article] [PubMed]
- 40.Mishra PK, Adameova A, Hill JA, Baines CP, Kang PM, Downey JM, et al. Guidelines for evaluating myocardial cell death. Am J Physiol Heart Circ Physiol. 2019;317(5):H891–922. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Akinrinmade O, Omoruyi S, Dietrich D, Ekpo O. Long-term consumption of fermented Rooibos herbal tea offers neuroprotection against ischemic brain injury in rats. Acta Neurobiol Exp (Wars). 2017;77(1):94–105. [DOI] [PubMed] [Google Scholar]
- 42.Zhang Y, Fu K, Wang C, Ma C, Gong L, Zhou H, et al. Protective effects of dietary Quercetin on cerebral ischemic injury: pharmacology, pharmacokinetics and bioavailability-enhancing nanoformulations. Food Funct. 2023;14(10):4470–89. [DOI] [PubMed] [Google Scholar]
- 43.Pandher R, Puvanendran A, Diamond TH. The dangers of herbal teas: hypertension and weakness caused by liquorice-induced apparent mineralocorticoid excess. Med J Aust. 2020;213(5):207-e208201. [DOI] [PubMed] [Google Scholar]
- 44.Akcay M, Yuksel S. Resuscitated sudden cardiac death due to severe hypokalemia caused by Teff grain herbal tea: a case report. Turk Kardiyol Dern Ars. 2020;48(6):623–6. [DOI] [PubMed] [Google Scholar]
- 45.Hasnie AA, Baniahmad O, Tolwani A, McElderry HT, Prabhu SD. Complete heart block without ventricular escape secondary to hyperkalemia induced by herbal tea. HeartRhythm Case Rep. 2022;8(1):45–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Costa I, Mendonca MD, Cruz ESV, Calado S, Viana-Baptista M. Herbal supplements association with reversible cerebral vasoconstriction syndrome: a case report. J Stroke Cerebrovasc Dis. 2017;26(3):673–6. [DOI] [PubMed] [Google Scholar]
Associated Data
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Supplementary Materials
Data Availability Statement
Data from the Multi-Ethnic Study of Atherosclerosis (MESA) study can be requested through the National Institutes of Health’s Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) open program, accessible at https://biolincc.nhlbi.nih.gov/studies/mesa/.