***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background —Epidemiological studies suggest that tea consumption decreases cardiovascular risk , but the mechanisms of benefit remain undefined . Endothelial dysfunction has been associated with coronary artery disease and increased oxidative stress . Some antioxidants have been shown to reverse endothelial dysfunction , and tea contains antioxidant flavonoids . Methods and Results —To test the hypothesis that tea consumption will reverse endothelial dysfunction , we r and omized 66 patients with proven coronary artery disease to consume black tea and water in a crossover design . Short-term effects were examined 2 hours after consumption of 450 mL tea or water . Long-term effects were examined after consumption of 900 mL tea or water daily for 4 weeks . Vasomotor function of the brachial artery was examined at baseline and after each intervention with vascular ultrasound .  Fifty patients completed the protocol and had technically suitable ultrasound measurements . Both short- and long-term tea consumption improved endothelium- dependent flow-mediated dilation of the brachial artery , whereas consumption of water had no effect ( P < 0.001 by repeated- measures ANOVA ) . Tea consumption had no effect on endothelium-independent nitroglycerin-induced dilation . An equivalent oral dose of caffeine ( 200 mg ) had no short-term effect on flow-mediated dilation . Plasma flavonoids increased after short- and long-term tea consumption . Conclusions —Short- and long-term black tea consumption reverses endothelial vasomotor dysfunction in patients with coronary artery disease . This finding may partly explain the association between tea intake and decreased cardiovascular disease events BACKGROUND Polyunsaturated fatty acids ( PUFAs ) are intrinsic cell membrane components and closely involved in neurotransmission and receptor function . Lower omega-3 levels are associated with increased risk of coronary artery disease ( CAD ) , increases in cardiac events in CAD patients , and depression . We sought to examine relationships between depression and serum levels of omega-3 and omega-6 PUFAs in patients recovering from acute coronary syndromes ( ACS ) . METHODS We carried out a case-control study of serum  PUFA levels and current major depression in 54 age- and sex-matched pairs approximately 2 months following ACS .  RESULTS Depressed patients had significantly lower concentrations of total omega-3 and docosahexaenoic acid ( DHA ) , and higher ratios of arachidonic acid ( AA ) to DHA , AA to eicosapentaenoic acid ( EPA ) , and n-3 to n-6 than controls . There were no baseline differences in any potential risk or protective factors for depression . CONCLUSIONS Results are consistent with previous reports in depressed patients without CAD , and with literature concerning omega-3 levels and risk of CAD events . Dietary , genetic , and hormonal factors may all play a role in both depression and CAD . Both prospect i ve studies and r and omized trials are needed to help clarify the interrelationships Abstract —Epidemiological studies suggest that tea consumption is associated with a decreased risk of cardiovascular events , but the mechanisms of benefit remain undefined . Platelet aggregation is a precipitating event in cardiovascular disease , and tea contains antioxidant flavonoids that are known to decrease platelet aggregation in vitro . To test the effect of tea consumption on platelet aggregation , we r and omized 49 patients with coronary artery disease to either 450 mL of black tea or water consumed initially , followed by 900 mL of tea or water daily for 4 weeks in a crossover design . Ex vivo platelet aggregation in platelet-rich plasma was assessed in response to ADP and thrombin receptor-activating peptide at baseline and 2 hours and 4 weeks after beverage consumption . We observed dose-dependent platelet aggregation in response to each agonist , and neither relation was altered by acute or chronic tea consumption . Plasma flavonoids increased with acute and chronic tea consumption , indicating adequate absorption of tea flavonoids . In conclusion , these results demonstrate that acute and chronic black tea consumption does not affect ex vivo platelet aggregation in patients with coronary artery disease . These findings suggest that an effect of tea flavonoids on platelet aggregation is unlikely to be the explanation for the reduction in risk of cardiovascular events noted in epidemiological studies BACKGROUND The Lyon Diet Heart Study is a r and omized secondary prevention trial aim ed at testing whether a Mediterranean-type diet may reduce the rate of recurrence  after a first myocardial infa rct ion . An intermediate analysis showed a striking protective effect after 27 months of follow-up . This report presents results of an extended follow-up ( with a mean of 46 months per patient ) and deals with the relationships of dietary patterns and traditional risk factors with recurrence . METHODS AND RESULTS Three composite outcomes ( COs ) combining either cardiac death and nonfatal myocardial infa rct ion ( CO 1 ) , or the preceding plus major secondary end points ( unstable angina , stroke , heart failure , pulmonary or peripheral embolism ) ( CO 2 ) , or the preceding plus minor events requiring hospital admission ( CO 3 ) were studied . In the  Mediterranean diet group , CO 1 was reduced ( 14 events versus 44 in the prudent Western-type diet group , P=0.0001 ) , as were CO 2 ( 27 events versus 90 , P=0.0001 ) and CO 3 ( 95 events versus 180 , P=0 . 0002 ) . Adjusted risk ratios ranged from 0.28 to 0.53 . Among the traditional risk factors , total cholesterol ( 1 mmol/L being associated with an increased risk of 18 % to 28 % ) , systolic blood pressure ( 1 mm Hg being associated with an increased risk of 1 % to 2 % ) , leukocyte count ( adjusted risk ratios ranging from 1.64 to 2.86 with count > 9x10(9)/L ) , female sex ( adjusted risk ratios , 0.27 to 0 . 46 ) , and aspirin use ( adjusted risk ratios , 0.59 to 0.82 ) were each significantly and independently associated with recurrence . CONCLUSIONS The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infa rct ion , confirming previous intermediate analyses . Major traditional risk factors , such as high blood cholesterol and blood pressure , were shown to be independent and joint predictors of recurrence , indicating that the Mediterranean dietary pattern did not alter , at least qualitatively , the usual relationships between major risk factors and recurrence . Thus , a comprehensive strategy to decrease cardiovascular morbidity and mortality should include primarily a cardioprotective diet . It should be associated with other ( pharmacological ? ) means aim ed at reducing modifiable risk factors . Further trials combining the 2 approaches are warranted BACKGROUND Tumor necrosis factor alpha ( TNF-alpha ) mediates inflammation . High TNF-alpha production has adverse effects during disease . Polymorphisms in the TNF-alpha and lymphotoxin alpha genes influence TNF-alpha production . Fish oil suppresses TNF-alpha production and has variable antiinflammatory effects on disease . OBJECTIVE We examined the relation between TNF-alpha and lymphotoxin alpha genotypes and the ability of dietary fish oil to suppress TNF-alpha production by peripheral blood mononuclear cells ( P BMC s ) in healthy men . DESIGN Polymorphisms in the TNF-alpha ( TNF*1 and TNF*2 ) and lymphotoxin alpha ( TNFB*1 and TNFB*2 ) genes were determined in 111 healthy young men .  TNF-alpha production by endotoxin-stimulated P BMC s was measured before and 12 wk after dietary supplementation with fish oil ( 6 g/d ) . RESULTS Homozygosity for TNFB*2 was 2.5 times more frequent in the highest than in the lowest tertile of inherent TNF-alpha production . The percentage of subjects in whom fish oil suppressed TNF-alpha production was lowest ( 22 % ) in the lowest tertile and doubled with each ascending tertile . In the highest and lowest tertiles , mean TNF-alpha production decreased by 43 % ( P < 0.05 ) and increased by 160 % ( P < 0.05 ) , respectively . In the lowest tertile of TNF-alpha production , only TNFB*1/TNFB*2 heterozygous subjects were responsive to the suppressive effect of fish oil . In the middle tertile , this genotype was 6 times more frequent than the other lymphotoxin alpha genotypes among responsive individuals . In the highest tertile , responsiveness to fish oil appeared unrelated to lymphotoxin alpha genotype . CONCLUSION The ability of fish oil to decrease TNF-alpha production is influenced by inherent TNF-alpha production and by polymorphisms in the TNF-alpha and lymphotoxin alpha genes BACKGROUND Higher intakes of fish and n-3 fatty acids are associated with a reduced risk of cardiovascular events and mortality . However , limited data exist on the effect of fish intake on actual measures of progression of coronary artery atherosclerosis . OBJECTIVE The aim was to examine the association between fish intake and the progression of coronary artery atherosclerosis in women with coronary artery disease . DESIGN This was a prospect i ve cohort study of postmenopausal women ( n = 229 ) participating in the Estrogen Replacement and Atherosclerosis trial . Usual fish intake was estimated at baseline with a food-frequency question naire . Quantitative coronary angiography was performed at baseline and after 3.2 + /- 0.6 ( x + /- SD ) y to evaluate changes in the mean minimum coronary artery diameter , the mean percentage of stenosis , and the development of new coronary lesions . RESULTS Compared with lower fish intakes , consumption of > or = 2 servings of fish or > or = 1 serving of tuna or dark fish per week was associated with smaller increases in the percentage of stenosis ( 4.54 + /- 1.37 % compared with -0.06 + /- 1.59 % and 5.12 + /- 1.48 % compared with 0.35 + /- 1.47 % , respectively ; P < 0.05 for both ) in diabetic women after adjustments for age , cardiovascular disease risk factors , and dietary intakes of fatty acids , cholesterol , fiber , and alcohol . These associations were not significant in nondiabetic women . Higher fish consumption was also associated with smaller decreases in minimum coronary artery diameter and fewer new lesions . CONCLUSIONS Consumption of fish is associated with a significantly reduced progression of coronary artery atherosclerosis in women with coronary artery disease OBJECTIVES To assess the impact of socio-economic status on the relationship between type of alcohol and  all-cause mortality .  DESIGN A prospect i ve population study . SETTING The Copenhagen City Heart Study , Denmark . SUBJECTS A total of 14,223 men and women participated in the first examination of The Copenhagen City Heart Study in 1976 - 1978 . The participants were followed up until 18th of September 2001 during which 7208 persons died . The effect of beer , wine and spirits on mortality was stratified according to levels of education , income and cohabitation , and the association was examined after controlling for intake of the other types of alcohol , and for sex , smoking , physical activity and body mass index . MAIN OUTCOME MEASURES Number and time of death from all causes . RESULTS Consumers of wine were better educated and wealthier compared with beer and spirits drinkers . The association between type of beverage and mortality was noticed to differ according to socio-economic level , especially where the apparent protective effect of wine consumption tended to be strongest in the lower income and educational groups . CONCLUSIONS This study finds the specific effects of beer , wine or spirits to moderately diverge in the socio-economic groups . Future studies addressing the association between the type of beverage and mortality may need to more thoroughly take socio-economic factors into account BACKGROUND Previous studies of diet and coronary heart disease ( CHD ) have focused on intake of nutrients rather than whole foods . Because of the findings that dietary fibre , folate and antioxidants may be protective for CHD , increased intake of vegetables has been recommended . However , due to the chemical and physical complexity of vegetables , the effects of individual nutrients may differ if eaten as whole foods . Moreover , little is known about the direct association between vegetable intake and risk of CHD . METHODS We prospect ively evaluated the relation between vegetable intake and CHD risk in the Physicians ' Health Study , a r and omized trial of aspirin and beta-carotene among 22 071 US male physicians aged 40 - 84 years in 1982 . In this analysis , we included 15 220 men without heart disease , stroke or cancer at baseline who provided information on their vegetable intake at baseline , and in the 2nd , 4th and 6th years of follow-up using a simple semiquantitative food frequency question naire including eight vegetables . We confirmed 1148 incident cases of CHD ( 387 incident cases of myocardial infa rct ion and 761 incident cases of coronary artery bypass grafting or percutaneous transluminal coronary angioplasty ) during 12 years of follow-up . RESULTS After adjusting for age , r and omized treatment , body mass index ( BMI ) , smoking , alcohol intake , physical activity , history of diabetes , history of hypertension , history of high cholesterol , and use of multivitamins 
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Results show substantial evidence for the efficacy of n-3 oils in reducing cardiovascular mortality and one mechanism may be related to the stabilisation of vulnerable atherosclerotic plaques , although the effects on progression of atherosclerosis , haemostatic activity and vascular inflammation remain equivocal .
Promising data also exist for the efficacy of flavonoid-rich foods for improving endothelial function , although strong clinical endpoint evidence is lacking .
The variation in the efficacy of certain nutrients in CHD patients may be explained by genetics , existing risk factors , psychosocial factors and method ological issues , although these are often not adequately taken into consideration .