Abstract
Epidemiologic studies have suggested an inverse association between flavonoids and cardiovascular disease (CVD). However, the results might have been influenced by the use of dietary assessment methods, which are error prone. The aim of this paper was to systematically review and analyse the literature for evidence of associations between polyphenol biomarkers and CVD and mortality risk in observational studies. Eligible studies were identified through PubMed, Web of Science, and reference lists. Multivariable adjusted associations were extracted. Data were log-transformed and pooled using the random effects model. In total, eight studies were included, investigating 16 different polyphenol biomarkers in association with CVD and mortality. Blood and urine were used as biospecimens, and enterolactone, a lignan metabolite, was most often investigated. Three meta-analyses were conducted investigating the association between enterolactone, and all-cause and CVD mortality, and non-fatal myocardial infarction. A 30% and 45% reduced all-cause and CVD mortality risk were revealed at higher enterolactone concentrations. Furthermore, inverse associations were observed between polyphenol biomarkers and all-cause mortality, kaempferol, and acute coronary syndrome. There is evidence to suggest that enterolactone is associated with a lower CVD mortality risk. This emphasises the importance of the role of the microbiota in disease prevention. To strengthen the evidence, more studies are warranted.
Highlights
Cardiovascular diseases (CVD) are the leading cause of death worldwide [1]
Inverse associations were observed between polyphenol biomarkers and all-cause mortality, kaempferol, and acute coronary syndrome
A number of studies have been published reporting on the associations between polyphenol biomarkers, and all-cause, cardiovascular disease (CVD) mortality, and CVD risk
Summary
Cardiovascular diseases (CVD) are the leading cause of death worldwide [1]. By tackling modifiable lifestyle factors such as an unhealthy diet, most CVDs could in theory be prevented.A healthy diet containing plant-based foods [1] is abundant in bioactive compounds, such as polyphenols. Over 500 different heterogeneous molecular structures of polyphenols have been identified in plant foods [2] Based on their structure, four groups of polyphenols can be distinguished, including flavonoids, phenolic acids, stilbenes, and lignans [3,4,5]. Relatively abundant in plant foods are phenolic acids (coffee, outer part of fruits); with respect to disease risk, they have been investigated less often [5]. This is the case for stilbenes, which are less dispersed in Nutrients 2017, 9, 415; doi:10.3390/nu9040415 www.mdpi.com/journal/nutrients
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