Abstract
Background: Although increased fruit intake reduces cardiovascular disease (CVD) risk, which fruits are most beneficial and what key constituents are responsible are unclear. Habitual intakes of flavonoids, specifically anthocyanins and flavanones, in which >90% of habitual intake is derived from fruit, are associated with decreased CVD risk in women, but associations in men are largely unknown.Objective: We examined the relation between habitual anthocyanin and flavanone intake and coronary artery disease and stroke in the Health Professionals Follow-Up Study.Design: We followed 43,880 healthy men who had no prior diagnosed CVD or cancer. Flavonoid intake was calculated with the use of validated food-frequency questionnaires.Results: During 24 y of follow-up, 4046 myocardial infarction (MI) and 1572 stroke cases were confirmed by medical records. Although higher anthocyanin intake was not associated with total or fatal MI risk, after multivariate adjustment an inverse association with nonfatal MI was observed (HR: 0.87; 95% CI: 0.75, 1.00; P = 0.04; P-trend = 0.098); this association was stronger in normotensive participants (HR: 0.81; 95% CI: 0.69, 0.96; P-interaction = 0.03). Anthocyanin intake was not associated with stroke risk. Although flavanone intake was not associated with MI or total stroke risk, higher intake was associated with a lower risk of ischemic stroke (HR: 0.78; 95% CI: 0.62, 0.97; P = 0.03, P-trend = 0.059), with the greatest magnitude in participants aged ≥65 y (P-interaction = 0.04).Conclusions: Higher intakes of fruit-based flavonoids were associated with a lower risk of nonfatal MI and ischemic stroke in men. Mechanistic studies and clinical trials are needed to unravel the differential benefits of anthocyanin- and flavanone-rich foods on cardiovascular health.
Highlights
Recent data suggest that dietary fruit intake is the third most important modifiable risk factor for reducing global rates of noncommunicable diseases after high blood pressure and smoking [1]
When we restricted follow-up to 1998 (12 y), the findings did not change. In this prospective cohort study of well-characterized men with 24 y of follow-up, we observed that a higher intake of anthocyanins was associated with a 14% lower risk of nonfatal myocardial infarction (MI) and a higher intake of flavanones was associated with a 22% lower risk of ischemic stroke; these inverse associations were independent of established dietary and nondietary cardiovascular disease (CVD) risk factors
The few prospective cohort studies that have examined associations between habitual anthocyanin intake and CVD risk have predominantly focused on women
Summary
Recent data suggest that dietary fruit intake is the third most important modifiable risk factor for reducing global rates of noncommunicable diseases after high blood pressure and smoking [1]. Fruit contributes to the intake of several different flavonoid subclasses, in the habitual diet .90% of the intake of 2 main subclasses of flavonoids, anthocyanins and flavanones, is derived from fruit [3, 6] Supportive data for their effects on vascular function come from mechanistic studies and show that their downstream metabolites can alter signaling pathways involved in vascular inflammation, inhibit atherosclerosis development, improve endothelial function principally via improved blood flow, enhance production or reduce NAD(P)H oxidasedependent elimination of endothelial nitric oxide, and inhibit platelet function [11,12,13,14]. Conclusions: Higher intakes of fruit-based flavonoids were associated with a lower risk of nonfatal MI and ischemic stroke in men.
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