Abstract
Cardiovascular disease (CVD) remains the leading cause of death today. Many of the biochemical alterations associated with the pathophysiology of CVD can be modified by adequate intakes of bioactive nutrients through a correct diet or supplementation. Recently, there has been growing public and clinical interest in cocoa polyphenols (CPs) and omega-3 (ω-3) fatty acids. A plethora of nutritional intervention trials and experimental studies demonstrates that consumption of these bioactive food compounds is beneficial to promote cardiovascular health. The purpose of this review is to summarize the major cardioprotective effects of CPs and ω-3 fatty acids, providing a scientific rationale for incorporating the combination of these molecules as a nutritional intervention in the prevention of CVD. Although several studies have shown the individual cardioprotective nature of these compounds, a combination treatment with CPs and ω-3 fatty acids may be a promising approach to enhance the preventive value of these molecules and reduce cardiovascular risk factors associated with aging. Therefore, this article also reviews some of the key studies on the interaction between CPs and the metabolism of ω-3 fatty acids.
Highlights
Cardiovascular disease (CVD) is the leading cause of death today
Even though little clinical evidence exists that consumption of cocoa polyphenols (CPs) may reduce inflammation, a randomized clinical trial with proanthocyanidine-rich cocoa powder demonstrated a reduction in plasma markers of inflammation in adults with high CVD risk.[56]
The ongoing Cocoa Supplement and Multivitamin Outcomes Study (COSMOS), which aims to determine the efficacy of a flavanol-rich cocoa using a 5-year randomized trial among 18,000 healthy men and women, may provide definitive evidence on the health benefits of cocoa on cardiovascular outcomes.[104]
Summary
Cardiovascular disease (CVD) is the leading cause of death today. Across the world, CVD results in 1 in 3 deaths per year and more than half of the deaths related to CVD occurs in individuals aged 65–74 years.[1]. Regular cocoa flavanols intake improved cardiovascular biomarkers, demonstrating that dietary flavanols have the potential to maintain cardiovascular health even in lowrisk subjects.[54] Cocoa flavanols have a strong antiinflammatory properties in vitro but recent human studies reported a modest support to the anti-inflammatory effect of cocoa.[55] even though little clinical evidence exists that consumption of CPs may reduce inflammation, a randomized clinical trial with proanthocyanidine-rich cocoa powder demonstrated a reduction in plasma markers of inflammation in adults with high CVD risk.[56] Some studies suggest that cocoa flavonoids may inhibit platelet aggregation by downregulating cellular eicosanoid synthesis.[57,58,59] Eicosanoids are lipidic products involved in the regulation of the vascular tone and recruitment of immune cells into the vascular wall Eicosanoids such as PGE2, TxA2, and LT4 are derivatives of the AA and mediators involved in the inflammatory response. PUFAs are not yet understood, recent data show that dietary flavonoids interact with the metabolism of LC x-3 PUFAs and increase blood EPA and DHA levels.[103]
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