Abstract
Background: Epidemiological and experimental evidence support a protective effect of dietary polyphenols on chronic diseases, but high quality longitudinal data are needed, including details on categories of polyphenols. Our objective was to investigate the prospective association between total and individual classes and subclasses of dietary polyphenols and the risk of major cardiovascular disease in the NutriNet-Santé cohort. Methods: A total of 84,158 participants, who completed at least three 24 h dietary records, were included between May 2009 and June 2017. Individual polyphenols intakes were obtained by matching food consumption data from the 24 h dietary records with the Phenol-Explorer polyphenol composition database. Multivariable Cox proportional hazards models were used to characterize the associations between dietary polyphenols and the incidence of cardiovascular diseases, comparing tertile T3 vs. T1 of classes and subclasses of polyphenols. Results: Over a median of 4.9 years of follow-up, 602 major cardiovascular events were diagnosed. Intakes of anthocyanins, catechins, and flavonols were strongly inversely associated with cardiovascular disease risk (anthocyanins: Hazard Ratio (HR)for a 1-point increment of 10 mg/day = 0.98 (0.96–0.99, p = 0.03, HRT3vs.T1 = 0.66 (0.52–0.83), ptrend = 0.0003; catechins: HRfor a 1-point increment of 10 mg/day = 0.98 (0.96–0.99), p = 0.02, HRT3vs.T1 = 0.74 (0.60–0.91), ptrend = 0.004; flavonols: HRfor a 1-point increment of 10 mg/day = 0.94 (0.90–0.99), p = 0.02, HRT3vs.T1 = 0.75 (0.61–0.94), ptrend = 0.006). Intakes of dihydrochalcones, proanthocyaninidins, dihydroflavonols, hydroxybenzoic acids, and stilbenes were also associated with a decrease (13%, 19%, 24%, 24%, and 27%, respectively) in cardiovascular disease risk, when comparing tertile T3 to T1. Conclusions: Higher intakes of polyphenols, especially of anthocyanins, catechins, and flavonols, were associated with a statistically significant decreased cardiovascular disease risk.
Highlights
Cardiovascular diseases (CVDs) account for almost one third of deaths worldwide [1]; diet plays a decisive role among the modifiable environmental factors involved in the aetiology of CVDs [2].Polyphenols are bioactive phytochemicals present in plant foods and beverages, classified into four major classes according to their chemical structure, each class being further divided into subclasses [3]
Few prospective studies on the association between polyphenol classes and subclasses and CVD risk were based on such detailed polyphenol intake data considering coefficient cooking factors as well as a broad range of classes of polyphenols
Consistent with our findings, studies evaluating the associations between flavonoids and the risk of CVDs have shown significant inverse associations [36,37]
Summary
Cardiovascular diseases (CVDs) account for almost one third of deaths worldwide [1]; diet plays a decisive role among the modifiable environmental factors involved in the aetiology of CVDs [2].Polyphenols are bioactive phytochemicals present in plant foods and beverages, classified into four major classes according to their chemical structure (flavonoids, phenolic acids, stilbenes, and lignans), each class being further divided into subclasses [3]. A large number of preclinical and clinical studies suggest a protective role of dietary polyphenols against CVDs [4], and several major risk factors of CVDs, such as hypertension, overweight, dyslipidaemia, or diabetes [5]. Our objective was to investigate the prospective association between total and individual classes and subclasses of dietary polyphenols and the risk of major cardiovascular disease in the NutriNet-Santé cohort. Individual polyphenols intakes were obtained by matching food consumption data from the 24 h dietary records with the Phenol-Explorer polyphenol composition database. Multivariable Cox proportional hazards models were used to characterize the associations between dietary polyphenols and the incidence of cardiovascular diseases, comparing tertile T3 vs T1 of classes and subclasses of polyphenols.
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