title: Associations between flavan-3-ol intake and CVD risk in the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk).
abstract: Dietary intervention studies suggest that flavan-3-ol intake can improve vascular function and reduce the risk of cardiovascular diseases (CVD). However, results from prospective studies failed to show a consistent beneficial effect. Associations between flavan-3-ol intake and CVD risk in the Norfolk arm of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) were investigated. Data were available from 24,885 (11,252 men; 13,633 women) participants, recruited between 1993 and 1997 into the EPIC-Norfolk study. Flavan-3-ol intake was assessed using 7-day food diaries and the FLAVIOLA Flavanol Food Composition database. Missing data for plasma cholesterol and vitamin C were imputed using multiple imputation. Associations between flavan-3-ol intake and blood pressure at baseline were determined using linear regression models. Associations with CVD risk were estimated using Cox regression analyses. Median intake of total flavan-3-ols was 1034mg/d (range: 0-8531mg/d) for men and 970mg/d (0-6695mg/d) for women, median intake of flavan-3-ol monomers was 233mg/d (0-3248mg/d) for men and 217 (0-2712mg/d) for women. There were no consistent associations between flavan-3-ol monomer intake and baseline systolic and diastolic blood pressure (BP). After 286,147 person-years of follow-up, there were 8463 cardiovascular events and 1987 CVD related deaths; no consistent association between flavan-3-ol intake and CVD risk (HR 0.93, 95% CI: 0.87; 1.00; Q1 vs Q5) or mortality was observed (HR 0.93, 95% CI: 0.84; 1.04). Flavan-3-ol intake in EPIC-Norfolk is not sufficient to achieve a statistically significant reduction in CVD risk.
authors: Department of Food & Nutritional Sciences, University of Reading, UK.
authors: Anna
authors: A
authors: Vogiatzoglou
authors: Department of Public Health and Primary Care, University of Cambridge, UK.
authors: Angela A
authors: AA
authors: Mulligan
authors: Department of Public Health and Primary Care, University of Cambridge, UK.
authors: Amit
authors: A
authors: Bhaniani
authors: Department of Public Health and Primary Care, University of Cambridge, UK.
authors: Marleen A H
authors: MAH
authors: Lentjes
authors: Department of Public Health and Primary Care, University of Cambridge, UK.
authors: Alison
authors: A
authors: McTaggart
authors: Department of Public Health and Primary Care, University of Cambridge, UK.
authors: Robert N
authors: RN
authors: Luben
authors: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Germany.
authors: Christian
authors: C
authors: Heiss
authors: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Germany.
authors: Malte
authors: M
authors: Kelm
authors: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Germany.
authors: Marc W
authors: MW
authors: Merx
authors: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Germany.
authors: Jeremy P E
authors: JPE
authors: Spencer
authors: Mars, Inc., McLean, VA 22101, USA.
authors: Hagen
authors: H
authors: Schroeter
authors: Department of Public Health and Primary Care, University of Cambridge, UK; University of Cambridge, School of Clinical Medicine, Clinical Gerontology Unit, Cambridge, UK.
authors: Kay-Tee
authors: KT
authors: Khaw
authors: Department of Food & Nutritional Sciences, University of Reading, UK; Department of Public Health and Primary Care, University of Cambridge, UK. Electronic address: g.g.kuhnle@reading.ac.uk.
authors: Gunter G C
authors: GGC
authors: Kuhnle
mesh_terms: D000328:Adult; D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D004032:Diet; D005260:Female; D005419:Flavonoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D002317:Cardiovascular Agents; D005419:Flavonoids; C404987:flavan-3-ol
keywords: Cardio-vascular diseases; EPIC Norfolk; Flavan-3-ols; Nutritional epidemiology