Skip to main content
Log in

Flavonoids for reduction of atherosclerotic risk

  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Flavonoids are polyphenolic compounds found in fruits, vegetables, and beverages derived from plants. Foods thought historically by many societies to have healing properties—cocoa, red wine, and tea—are particularly rich in flavonoids. A majority of prospective cohort studies demonstrate a significant inverse association between flavonoid consumption and cardiovascular risk. Short-term studies demonstrate numerous plausible mechanisms by which flavonoids may confer cardiovascular protection: they inhibit low-density lipoprotein oxidation, reduce thrombosis, improve endothelial function, and reduce inflammation. No long-term, randomized, controlled trials of flavonoids with hard clinical endpoints have been conducted. Although there are no recommended daily intake goals for flavonoids, the data presented provide additional rationale to eat a diet containing a variety of flavonoid-rich foods and beverages.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Hu FB, Willett WC: Optimal diets for prevention of coronary heart disease. JAMA 2002, 288:2569–2578.

    Article  PubMed  CAS  Google Scholar 

  2. Steinberg FM, Bearden MM, Keen CL: Cocoa and chocolate flavonoids: implications for cardiovascular health. J Am Diet Assoc 2003, 103:215–223.

    Article  PubMed  Google Scholar 

  3. Ross JA, Kasum CM: Dietary flavonoids: bioavailability, metabolic effects, and safety. Annu Rev Nutr 2002, 22:19–34.

    Article  PubMed  CAS  Google Scholar 

  4. Rice-Evans CA, Miller NJ, Paganga G: Structure-antioxidant activity relationships of flavonoids and phenolic acids. Free Radic Biol Med 1996, 20:933–956.

    Article  PubMed  CAS  Google Scholar 

  5. Hertog MG, Feskens EJ, Hollman PC, et al.: Dietary antioxidant flavonoids and risk of coronary heart disease: the Zutphen Elderly Study. Lancet 1993, 342:1007–1011.

    Article  PubMed  CAS  Google Scholar 

  6. Hertog MG, Kromhout D, Aravanis C, et al.: Flavonoid intake and long-term risk of coronary heart disease and cancer in the Seven Countries Study. Arch Intern Med 1995, 155:381–386.

    Article  PubMed  CAS  Google Scholar 

  7. Keli SO, Hertog MG, Feskens EJ, Kromhout D: Dietary flavonoids, antioxidant vitamins, and the incidence of stroke: the Zutphen Study. Arch Intern Med 1996, 156:637–642.

    Article  PubMed  CAS  Google Scholar 

  8. Knekt P, Jarvinen F, Reunanen A, Maatela J: Flavonoid intake and coronary mortality in Finland: a cohort study. BMJ 1996, 312:478–481.

    PubMed  CAS  Google Scholar 

  9. Hertog MG, Feskens EJ, Kromhout D: Antioxidant flavonols and coronary heart disease risk [letter]. Lancet 1997, 349:699.

    Article  PubMed  CAS  Google Scholar 

  10. Yochum L, Kushi LH, Meyer K, Folsom AR: Dietary flavonoid intake and risk of cardiovascular disease in postmenopausal women. Am J Epidemiol 1999, 149:943–949.

    PubMed  CAS  Google Scholar 

  11. Hirvonen T, Pietinen P, Virtanen et al.: Intake of flavonols and flavones and risk of coronary heart disease in male smokers. Epidemiology 2001, 12:62–67.

    Article  PubMed  CAS  Google Scholar 

  12. Knekt P, Kumpulainen J, Järvinen R, et al.: Flavonoid intake and risk of chronic disease. Am J Clin Nutr 2002, 76:560–568.

    PubMed  CAS  Google Scholar 

  13. Geleijnse JM, Launer LJ, van der Kuip DA, et al.: Inverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study. Am J Clin Nutr 2002, 75:880–886.

    PubMed  CAS  Google Scholar 

  14. Hertog MG, Sweetnam PM, Fehily AM, et al.: Antioxidant flavonols and ischemic heart disease in a Welsh population of men: the Caerphilly Study. Am J Clin Nutr 1997, 65:1489–1494.

    PubMed  CAS  Google Scholar 

  15. Rimm EB, Katan MB, Ascherio A, et al.: Relation between intake of flavonoids and risk for coronary heart disease in male health professionals. Ann Intern Med 1996, 125:384–389.

    PubMed  CAS  Google Scholar 

  16. Hirvonen T, Virtamo J, Korhonen P, et al.: Intake of flavonoids, carotenoids, vitamins C and E, and risk of stroke in male smokers. Stroke 2000, 31:2301–2306.

    PubMed  CAS  Google Scholar 

  17. Sesso HD, Gaziano JM, Liu S, Buring JE: Flavonoid intake and the risk of cardiovascular disease in women. Am J Clin Nutr 2003, 77:1400–1408.

    PubMed  CAS  Google Scholar 

  18. Kris-Etherton PM, Keen CL: Evidence that the antioxidant flavonoids in tea and cocoa are beneficial for cardiovascular health. Curr Opin Lipidol 2002, 13:41–49.

    Article  PubMed  CAS  Google Scholar 

  19. Arts IC, Hollman PC, Kromhout D: Chocolate as a source of tea flavonoids. Lancet 1999, 354:488.

    Article  PubMed  CAS  Google Scholar 

  20. Osakabe N, Baba S, Yasuda A, et al.: Daily cocoa intake reduces the susceptibility of low-density lipoprotein to oxidation as demonstrated in healthy human olunteers. Free Radic Biol Res 2001, 34:93–99.

    Article  CAS  Google Scholar 

  21. Wan Y, Vinson JA, Etherton TD, et al.: Effects of cocoa powder and dark chocolate on LDL oxidative susceptibility and prostaglandin concentration in humans. Am J Clin Nutr 2001, 74:596–602.

    PubMed  CAS  Google Scholar 

  22. Rein D, Paglieroni TG, Pearson DA, et al.: Cocoa and wine polyphenols modulate platelet activation and function. J Nutr 2000, 130:2120S-2126S.

    PubMed  CAS  Google Scholar 

  23. Schramm DD, Wang JF, Holt RR, et al.: Chocolate procyanidins decrease the leukotriene-prostacyclin ratio in humans and human aortic endothelial cells. Am J Clin Nutr 2001, 73:36–40.

    PubMed  CAS  Google Scholar 

  24. Karim M, McCormick K, Kappagoda CT: Effects of cocoa extracts on endothelium-dependent relaxation. J Nutr 2000, 130:2105S-2108S.

    PubMed  CAS  Google Scholar 

  25. Goldberg IJ, Mosca L, Piano MR, Fisher EA: Wine and your heart: a science advisory for healthcare professionals from the Nutrition Committee, Council on Epidemiology and Prevention, and Council on Cardiovascular Nursing for the American Heart Association. Circulation 2001, 103:472–475.

    PubMed  CAS  Google Scholar 

  26. Renaud S, de Lorgeril M: Wine, alcohol, platelets, and the French paradox for coronary heart disease. Lancet 1992, 339:1523–1526.

    Article  PubMed  CAS  Google Scholar 

  27. Aviram M, Fuhrman B: Wine flavonoids protect against LDL oxidation and atherosclerosis. Ann NY Acad Sci 2002, 957:146–161.

    Article  PubMed  CAS  Google Scholar 

  28. Frankel EN, Kanner J, German JB, et al.: Inhibition of oxidation of human low-density lipoprotein by phenolic substances in red wine. Lancet 1993, 341:454–457.

    Article  PubMed  CAS  Google Scholar 

  29. Pal S, Ho N, Santos C, et al.: Red wine polyphenolics increase LDL receptor expression and activity and suppress the secretion of apoprotein B 100 from human HepG2 cells. J Nutr 2003, 133:700–706.

    PubMed  CAS  Google Scholar 

  30. Hashimoto M, Kim S, Eto M, et al.: Effect of acute intake of red wine on flow-mediated vasodilation of the brachial artery. Am J Cardiol 2001, 88:1457–1460.

    Article  PubMed  CAS  Google Scholar 

  31. Stein JH, Keevil JG, Wiebe DA, et al.: Purple grape juice improves endothelial function and reduces susceptibility of LDL cholesterol to oxidation in patients with coronary artery disease. Circulation 1999, 100:1050–1055.

    PubMed  CAS  Google Scholar 

  32. Corder R, Douthwaite JA, Lees DM, et al.: Endothelin-1 synthesis reduced by red wine. Nature 2001, 414:863–864.

    Article  PubMed  CAS  Google Scholar 

  33. Diebolt M, Bucher B, Andriantsitohaina R: Wine polyphenols decrease blood pressure, improve NO vasodilatation, and induce gene expression. Hypertension 2001, 38:159–165.

    PubMed  CAS  Google Scholar 

  34. Wallerath T, Poleo D, Li H, Förstermann U: Red wine increases the expression of human endothelial nitric oxide synthase: a mechanism that may contribute to its beneficial cardiovascular effects. J Am Coll Cardiol 2003, 41:471–478.

    Article  PubMed  CAS  Google Scholar 

  35. Iijima K, Yoshizumi M, Hashimoto M, et al.: Red wine polyphenols inhibit proliferation of vascular smooth muscle cells and down regulate expression of cyclin A gene. Circulation 2000, 101:805–811.

    PubMed  CAS  Google Scholar 

  36. Pignatelli P, Pulcinelli FM, Celestini A, et al.: The flavonoids quercetin and catechin synergistically inhibit platelet function by antagonizing the intracellular production of hydrogen peroxide. Am J Clin Nutr 2000, 72:1150–1155.

    PubMed  CAS  Google Scholar 

  37. Shanmuganayagam D, Beahm MR, Osman HE, et al.: Grape seed and grape skin extracts elicit a greater antiplatelet effect when used in combination than when used individually in dogs and humans. J Nutr 2002, 132:3592–3598.

    PubMed  CAS  Google Scholar 

  38. Peters U, Poole C, Arab L: Does tea affect cardiovascular disease? A meta-analysis. Am J Epidemiol 2001, 154:495–503.

    Article  PubMed  CAS  Google Scholar 

  39. Lakenbrink C, Lapezynski S, Maiwald B, Engelhardt UH: Flavonoids and other polyphenols in consumer brews of tea and other caffeinated beverages. J Agric Food Chem 2000, 48:2848–2852.

    Article  PubMed  CAS  Google Scholar 

  40. Ishikawa T, Suzukawa M, Ito T, et al.: Effect of tea flavonoid supplementation on the susceptibility of low-density lipoprotein to oxidative modification. Am J Clin Nutr 1997, 66:261–266.

    PubMed  CAS  Google Scholar 

  41. Duffy SJ, Keaney JF, Holbrook M, et al.: Short-and long-term black tea consumption reverses endothelial dysfunction in patients with coronary artery disease. Circulation 2001, 104:151–156.

    PubMed  CAS  Google Scholar 

  42. Duffy SJ, Vita JA, Holbrook M, et al.: Effect of acute and chronic tea consumption on platelet aggregation in patients with coronary artery disease. Arterioscler Thromb Vasc Biol 2001, 21:1084–1089.

    PubMed  CAS  Google Scholar 

  43. Loktionov A, Bingham SA, Vorster H, et al.: Apolipoprotein E genotype modulates the effect of black tea drinking on blood lipids and blood coagulation factors: a pilot study. Br J Nutr 1998, 79:133–139.

    Article  PubMed  CAS  Google Scholar 

  44. Middleton E, Kandaswami C, Theoharides TC: The Effects of plant flavonoids on mammalian cells: implications for inflammation, heart disease, and cancer. Pharmacol Rev 2000, 52:673–751.

    PubMed  CAS  Google Scholar 

  45. Riemersma RA, Rice-Evans CA, Tyrrell RM, et al.: Tea flavonoids and cardiovascular health. Q J Med 2001, 94:277–282.

    CAS  Google Scholar 

  46. Princen HM, van Duyvenvoorde W, Buytenhek R, et al.: No effect of consumption of green and black tea on plasma lipid an antioxidant levels and on LDL oxidation in smokers. Arterioscler Thromb Vasc Biol 1998, 18:833–841.

    PubMed  CAS  Google Scholar 

  47. Maron DJ, Lu GP, Cai NS, et al.: Cholesterol-lowering effect of a theaflavin-enriched green tea extract: a randomized controlled trial. Arch Intern Med 2003, 163:1448–1453.

    Article  PubMed  CAS  Google Scholar 

  48. Ikeda I, Imasato Y, Sasaki E, et al.: Tea catechins decrease micellar solubility and intestinal absorption of cholesterol in rats. Biochim Biophys Acta 1992, 1127:141–146.

    PubMed  CAS  Google Scholar 

  49. Yang TT, Koo MW: Chinese green tea lowers cholesterol level through an increase in fecal lipid excretion. Life Sci 2000, 66:411–423.

    Article  PubMed  CAS  Google Scholar 

  50. Sayama K, Lin S, Zheng G, Oguni I: Effects of green tea on growth, food utilization and lipid metabolism in mice. In Vivo 2000, 14:481–484.

    PubMed  CAS  Google Scholar 

  51. Bursill C, Roach PD, Bottema CD, Pal S: Green tea upregulates the low-density lipoprotein receptor through the sterol-regulated element binding protein in HepG2 liver cells. J Agric Food Chem 2001, 49:5639–5645.

    Article  PubMed  CAS  Google Scholar 

  52. Young W, Hotovec RL, Romero AG: Tea and atherosclerosis. Nature 1967, 216:1015–1016.

    PubMed  CAS  Google Scholar 

  53. Miura Y, Chiba T, Tomita I, et al.: Tea catechins prevent the development of atherosclerosis in apoprotein E-deficient mice. J Nutr 2001, 131:27–32.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maron, D.J. Flavonoids for reduction of atherosclerotic risk. Curr Atheroscler Rep 6, 73–78 (2004). https://doi.org/10.1007/s11883-004-0119-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11883-004-0119-1

Keywords

Navigation