Epidemiological studies have indicated that dietary flavonoids generally, and flavonols specifically, may contribute to cardiovascular health. Tea consumption, which is often the main dietary source of flavonoids and flavonols, is associated with a reduced risk of cardiovascular outcomes. The primary objective of the present study was to explore the association of the habitual intake of flavonols from tea and non-tea sources with the risk of atherosclerotic vascular disease mortality in a population of elderly women. A total of 1063 women, aged over 75 years, were randomly selected from ambulant Caucasian women living in Perth, Western Australia. Flavonoid consumption was assessed using the US Department of Agriculture Flavonoid, Flavone and Proanthocyanidin databases. Atherosclerotic vascular disease mortality was assessed over 5 years of follow-up through the Western Australian Data Linkage System. During the follow-up, sixty-four women died from atherosclerotic vascular disease. Women in the highest compared with the lowest tertile of flavonol intake had a lower risk of atherosclerotic vascular disease death (OR 0·27, 95 % CI 0·13, 0·59; P#0·01 for trend in multivariate-adjusted models). Similar relationships were observed for flavonol intake derived from both tea (OR 0·38, 95 % CI 0·18, 0·79; P, 0·01) and non-tea (OR 0·41, 95 % CI 0·20, 0·85; P¼0·05) sources. Tea was the main contributor to flavonol intake (65 %), and the intakes of flavonols from tea and non-tea sources were not significantly correlated. In conclusion, increased consumption of flavonols was independently associated with a lower risk of atherosclerotic vascular disease mortality. Both tea and non-tea sources of flavonols were independently associated with this benefit.
Key words: Tea: Flavonoids: Flavonols: Atherosclerotic vascular disease mortalityFlavonoids include a diverse group of over 6000 compounds (1) .There are seven major classes of flavonoids in the human diet, including flavonols, flavan-3-ols, proanthocyanidins, flavones, flavanones, anthocyanidins and isoflavones (2 -4) .Major dietary sources of flavonoids include tea, fruit and vegetables, chocolate and red wine. There is increasing evidence that dietary flavonoids generally, and flavonols specifically, contribute to cardiovascular health (5) . A number of population studies have investigated the relationships of specific flavonoid classes with CVD risk. Early population studies that assessed flavonol and flavone intakes have indicated a significant reduction in CHD mortality with a higher flavonol intake. A high flavonol intake has previously been associated with a 20 % lower risk of fatal CHD (6) .More recent studies have investigated the relationships of all seven major classes of flavonoids with CVD outcomes (7,8) .This has been made possible by recent improvements to food composition databases, which have allowed the assessment of all seven major classes of flavonoids (2 -4) . Tea is frequently the main source of flavonoids in the diet. It often contributes more...