Flavonoid intake and cardiovascular disease mortality in a prospective cohort of US adults.
BACKGROUND
Flavonoids are plant-based phytochemicals with cardiovascular protective properties. Few studies have comprehensively examined flavonoid classes in relation to cardiovascular disease mortality.


OBJECTIVE
We examined the association between flavonoid intake and cardiovascular disease (CVD) mortality among participants in a large, prospective US cohort.


METHODS
In 1999, a total of 38,180 men and 60,289 women in the Cancer Prevention Study II Nutrition Cohort with a mean age of 70 and 69 y, respectively, completed questionnaires on medical history and lifestyle behaviors, including a 152-item food-frequency questionnaire. Cox proportional hazards modeling was used to calculate multivariate-adjusted hazard RRs and 95% CIs for associations between total flavonoids, 7 flavonoid classes, and CVD mortality.


RESULTS
During 7 y of follow-up, 1589 CVD deaths in men and 1182 CVD deaths in women occurred. Men and women with total flavonoid intakes in the top (compared with the bottom) quintile had a lower risk of fatal CVD (RR: 0.82; 95% CI: 0.73, 0.92; P-trend = 0.01). Five flavonoid classes-anthocyanidins, flavan-3-ols, flavones, flavonols, and proanthocyanidins-were individually associated with lower risk of fatal CVD (all P-trend < 0.05). In men, total flavonoid intakes were more strongly associated with stroke mortality (RR: 0.63; 95% CI: 0.44, 0.89; P-trend = 0.04) than with ischemic heart disease (RR: 0.90; 95% CI: 0.72, 1.13). Many associations appeared to be nonlinear, with lower risk at intakes above the referent category.


CONCLUSIONS
Flavonoid consumption was associated with lower risk of death from CVD. Most inverse associations appeared with intermediate intakes, suggesting that even relatively small amounts of flavonoid-rich foods may be beneficial.
Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. marjimccullough@cancer.org
Marjorie L
ML
McCullough
Julia J
JJ
Peterson
Roshni
R
Patel
Paul F
PF
Jacques
Roma
R
Shah
Johanna T
JT
Dwyer
D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D004032:Diet; D004034:Diet Surveys; D005260:Female; D005419:Flavonoids / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000401:mortality; D008517:Phytotherapy; D010936:Plant Extracts / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012016:Reference Values; D012737:Sex Factors; D020521:Stroke / Q000401:mortality; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
D005419:Flavonoids; D010936:Plant Extracts