Abstract
Objective: To assess the association of dietary flavonol intake with the subsequent risk of coronary heart disease (CHD) mortality.
Design: Meta-analysis of prospective cohort studies published before September 2001. Studies were identified by MEDLINE and EMBASE searches and by scanning relevant reference lists. The following information was extracted from published reports: size of cohort, mean age, mean duration of follow-up, number of fatal CHD events, mean flavonol intake, main sources of flavonol intake, degree of adjustment for potential confounders, and the relation of CHD mortality to dietary flavonol intake measured at baseline.
Results: Seven prospective cohorts of men and women were identified including a total of 2087 fatal CHD events. Comparison of individuals in the top third with those in the bottom third of dietary flavonol intake yielded a combined risk ratio of 0.80 (95% CI 0.69–0.93) after adjustment for known CHD risk factors and other dietary components.
Conclusion: This overview of prospective cohort studies indicates that high dietary intake of flavonols from a small number of fruits and vegetables, tea and red wine may be associated with a reduced risk from CHD mortality in free-living populations.
Sponsorship: Institute for International Health, University of Sydney.
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References
Aherne SA & O'Brien NM (2000): Mechanism of protection by the flavonoids, quercetin and rutin, against tert-butylhydroperoxide- and menadione-induced DNA single strand breaks in Caco-2 cells. Free. Radic. Biol. Med. 29, 507–514.
Danesh J, Collins R, Appleby P & Peto R (1998): Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA. 279, 1477–1482.
Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico (1999): Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet. 354, 447–455.
Gryglewski RJ, Korbut R, Robak J & Swies J (1987): On the mechanism of antithrombotic action of flavonoids. Biochem. Pharmacol. 36, 317–322.
Hertog MGL, Feskens EJM & Hollman PCH (1992): Content of potentially anticarcinogenic flavonoids of 28 vegetables and 9 fruits commonly consumed in the Netherlands. J. Agric. Food. Chem. 40, 2379–2383.
Hertog MGL, Feskens EJM & van de Putte B (1993): Content of potentially anticarcinogenic flavonoids in tea infusions, wines and fruit juices. J. Agric. Food. Chem. 41, 1242–1246.
Hertog MG, Kromhout D, Aravanis C, Blackburn H, Buzina R, Fidanza F et al (1995): Flavonoid intake and long-term risk of coronary heart disease and cancer in the seven countries study. Arch. Intern. Med. 155, 381–386.
Hertog MG, Sweetnam PM, Fehily AM, Elwood PC & Kromhout D (1997): Antioxidant flavonols and ischemic heart disease in a Welsh population of men: the Caerphilly Study. Am. J. Clin. Nutr. 65, 1489–1494.
Hertog MG, Feskens EJ & Kromhout D (1997): Antioxidant flavonols and coronary heart disease risk. Lancet. 349, 699.
Hirvonen T, Pietinen P, Virtanen M, Ovaskainen ML, Hakkinen S, Albanes D et al (2001): Intake of flavonols and flavones and risk of coronary heart disease in male smokers. Epidemiology. 12, 62–67.
Hollman PC & Katan MB (1999): Dietary flavonoids: intake, health effects and bioavailability. Food Chem.Toxicol. 37, 937–942.
Heart Protection Study Collaborative Group (2002): MRC/BHF heart protection study of antioxidant vitamin supplementation in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 360, 23–33.
Kandaswami C & Middleton E (1994): Free radical scavenging and antioxidant activity of plant flavonoids. Adv Exp Med Biol. 366, 351–376.
Khaw KT, Bingham S, Welch A, Luben R, Wareham N, Oakes S et al (2001): Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. European Prospective Investigation into Cancer and Nutrition. Lancet. 357, 657–663.
Knekt P, Jarvinen R, Reunanen A & Maatela J (1996): Flavonoid intake and coronary mortality in Finland: a cohort study. BMJ. 312, 478–481.
Liu S, Manson JE, Lee IM, Cole SR, Hennekens CH, Willett WC et al (2000): Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study. Am J Clin Nutr. 72, 922–928.
Ness AR & Powles JW (1997): Fruit and vegetables, and cardiovascular disease: a review. Int J Epidemiol. 26, 1–13.
Pietinen P, Rimm EB, Korhonen P, Hartman AM, Willett WC, Albanes D et al (1996): Intake of dietary fiber and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Circulation. 94, 2720–2727.
Rimm EB, Katan MB, Ascherio A, Stampfer MJ & Willett WC (1996): Relation between intake of flavonoids and risk for coronary heart disease in male health professionals. Ann Intern Med. 125, 384–389.
Serafini M, Ghiselli A & Ferro-Luzzi A (1996): In vivo antioxidant effect of green and black tea in man. Eur. J. Clin Nutr. 50, 28–32.
Trichopoulou A & Vasilopoulou E (2000): Mediterranean diet and longevity. Br J Nutr. 84(Suppl 2), S205–S209.
Witztum JL & Steinberg D (1991): Role of oxidized low density lipoprotein in atherogenesis. J Clin Invest. 88, 1785–1792.
Yochum L, Kushi LH, Meyer K & Folsom AR (1999): Dietary flavonoid intake and risk of cardiovascular disease in postmenopausal women. Am J Epidemiol. 149, 943–949.
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Gary Whitlock for helpful comments on previous versions.
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Guarantor: RR Huxley.
Contributors: RRH conceived and conducted the analyses and wrote the report. HAWN made a significant contribution to the writing of the report.
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Huxley, R., Neil, H. The relation between dietary flavonol intake and coronary heart disease mortality: a meta-analysis of prospective cohort studies. Eur J Clin Nutr 57, 904–908 (2003). https://doi.org/10.1038/sj.ejcn.1601624
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DOI: https://doi.org/10.1038/sj.ejcn.1601624
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