title: Inverse association between habitual polyphenol intake and incidence of cardiovascular events in the PREDIMED study.
abstract: OBJECTIVE
  Epidemiologic and biological evidence supports an inverse association between polyphenol consumption and the risk of cardiovascular disease (CVD). However, no previous studies have prospectively evaluated the relationship between polyphenol intake and the incidence of CVD in such a comprehensive way. The aim was to evaluate the association between intakes of total polyphenol and polyphenol subgroups, and the risk of major cardiovascular events (myocardial infarction, stroke or death from cardiovascular causes) in the PREDIMED study.
  
  
  RESULTS
  The present work is an observational study within the PREDIMED trial. Over an average of 4.3 years of follow-up, there were 273 confirmed cases of CVD among the 7172 participants (96.3%) who completed a validated 137-item food frequency questionnaire (FFQ) at baseline. Polyphenol consumption was calculated by matching food consumption data from the FFQ with the Phenol-Explorer database on polyphenol content of each reported food. After multivariate adjustment, a 46% reduction in risk of CVD risk was observed comparing Q5 vs. Q1 of total polyphenol intake (HR = 0.54; 95% confidence interval [CI] = 0.33-0.91; P-trend = 0.04). The polyphenols with the strongest inverse associations were flavanols (HR = 0.40; CI 0.23-0.72; P-trend = 0.003), lignans (HR = 0.51; CI 0.30-0.86; P-trend = 0.007), and hydroxybenzoic acids (HR = 0.47; CI 0.26-0.86; P-trend 0.02).
  
  
  CONCLUSIONS
  Greater intake of polyphenols, especially from lignans, flavanols, and hydroxybenzoic acids, was associated with decreased CVD risk. Clinical trials are needed to confirm this effect and establish accurate dietary recommendations.
authors.affiliation: Department of Nutrition and Food Science, XaRTA, INSA, Pharmacy School, University of Barcelona (UB), Barcelona, Spain; CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain.
authors.forename: A
authors.initials: A
authors.lastname: Tresserra-Rimbau
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: Department of Nutrition and Food Science, XaRTA, INSA, Pharmacy School, University of Barcelona (UB), Barcelona, Spain; CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain.
authors.forename: A
authors.initials: A
authors.lastname: Medina-Remón
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Martínez-González
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Cardiovascular Epidemiology Unit, Municipal Institute for Medical Research, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: de la Torre
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Department of Epidemiology, Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Corella
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Human Nutrition Unit, School of Medicine, IISPV, University Rovira i Virgili, Reus, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Salas-Salvadó
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Department of Epidemiology, School of Medicine, University of Malaga, Málaga, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Gómez-Gracia
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Department of Family Medicine, Primary Care Division of Sevilla, San Pablo Health Center, Sevilla, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Lapetra
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Department of Cardiology, University Hospital of Alava, Vitoria, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Arós
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Institut Universitari d'Investigació en Ciències de la Salut, Palma de Mallorca, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Fiol
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Ros
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Palmas de Gran Canaria, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Serra-Majem
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Lipid Unit, Department of Internal Medicine, IDIBELL-Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, FIPEC, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Pintó
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Department of Biochemistry, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: G T
authors.initials: GT
authors.lastname: Saez
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Primary Care Division, Catalan Institute of Health, Institut d'Investigació en Atenció Primària Jordi Gol, Reus, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Basora
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Valencian Institute of Health, Valencia, Spain.
authors.forename: J V
authors.initials: JV
authors.lastname: Sorlí
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Department of Nutrition and Food Sciences, Physiology and Toxicology, University of Navarra, Pamplona, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Martínez
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; La Mina Primary Care Center, UB, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Vinyoles
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Nutrition and Lipids Metabolism, Instituto de la Grasa, Consejo Superior de Investigaciones Científicas, Sevilla, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Ruiz-Gutiérrez
authors.affiliation: CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain; Department of Internal Medicine, Hospital Clínic, IDIBAPS, UB, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Estruch
authors.affiliation: Department of Nutrition and Food Science, XaRTA, INSA, Pharmacy School, University of Barcelona (UB), Barcelona, Spain; CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Spain. Electronic address: lamuela@ub.edu.
authors.forename: R M
authors.initials: RM
authors.lastname: Lamuela-Raventós
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000367:Age Factors; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use; D000975:Antioxidants / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D015331:Cohort Studies; D038441:Diet, Mediterranean; D044948:Flavonols / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use; D005500:Follow-Up Studies; D062385:Hydroxybenzoates / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use; D015994:Incidence; D017705:Lignans / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D009754:Nuts / Q000737:chemistry; D000069463:Olive Oil; D010938:Plant Oils / Q000737:chemistry; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000975:Antioxidants; D044948:Flavonols; D062385:Hydroxybenzoates; D017705:Lignans; D000069463:Olive Oil; D010938:Plant Oils
keywords: Cardiovascular diseases; Diet; Epidemiology; Polyphenols