title: Dietary epicatechin intake and 25-y risk of cardiovascular mortality: the Zutphen Elderly Study.
abstract: Prospective cohort studies have shown that the consumption of cocoa and tea is associated with lower risk of cardiovascular diseases (CVDs), and cocoa and tea have been shown to improve CVD risk factors in randomized controlled trials. Cocoa and tea are major dietary sources of the flavan-3-ol epicatechin.
  
  
  
  We investigated the associations of dietary epicatechin intake with 25-y CVD mortality in elderly Dutch men.
  
  
  
  We used data from the Zutphen Elderly Study, which was a prospective cohort study of 774 men aged 65-84 y in 1985. Epicatechin intake was estimated 4 times in 15 y with the use of the crosscheck dietary history method. Time-dependent Cox proportional hazards models were used to investigate repeated measures of epicatechin intake in relation to 25-y CVD mortality.
  
  
  
  Mean intake of epicatechin was 15.2 ± 7.7 mg/d, and the major dietary sources were tea (51%), apples (28%), and cocoa (7%). During 25 y of follow-up, 329 men died from CVD, 148 died from coronary heart disease (CHD), and 72 men died from stroke. Risk of CHD mortality was 38% lower in men in the top tertile of epicatechin intake than in men in the bottom tertile of epicatechin intake (HR: 0.62; 95% CI: 0.39, 0.98). Epicatechin intake was also significantly associated with 46% lower risk of CVD mortality in men with prevalent CVD (HR: 0.54; 95% CI: 0.31, 0.96) but not in men who were free of CVD.
  
  
  
  We show, for the first time to our knowledge, that epicatechin intake is inversely related to CHD mortality in elderly men and to CVD mortality in prevalent cases of CVD. More studies are needed before conclusions can be drawn.
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; and Top Institute Food and Nutrition, Wageningen, Netherlands.
authors.forename: James I
authors.initials: JI
authors.lastname: Dower
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; and Top Institute Food and Nutrition, Wageningen, Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Geleijnse
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; and Top Institute Food and Nutrition, Wageningen, Netherlands peter.hollman@wur.nl.
authors.forename: Peter Ch
authors.identifier: 0000-0002-7510-6809
authors.initials: PCh
authors.lastname: Hollman
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; and.
authors.forename: Sabita S
authors.initials: SS
authors.lastname: Soedamah-Muthu
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; and.
authors.forename: Daan
authors.initials: D
authors.lastname: Kromhout
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002099:Cacao / Q000737:chemistry; D028241:Camellia sinensis / Q000737:chemistry*; D002318:Cardiovascular Diseases / Q000401:mortality*; D002392:Catechin / Q000627:therapeutic use*; D003327:Coronary Disease / Q000401:mortality; D004032:Diet; D002149:Energy Intake; D005419:Flavonoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D027845:Malus / Q000737:chemistry*; D008517:Phytotherapy; D010936:Plant Extracts / Q000494:pharmacology / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality
chemical_list: D005419:Flavonoids; D010936:Plant Extracts; C404987:flavan-3-ol; D002392:Catechin
keywords: cardiovascular disease; cocoa; epicatechin; flavan-3-ols; tea