Circulation, Nov 6, 2018, Vol.138(S_1 Suppl 1), p.A15383(1)
Byline: Nicola P Bondonno, Health and Med Sciences, Univ of Western Australia, Perth, Australia; Frederik Dalgaard, Cardiology, Herlev & Gentofte Univ Hosp, Copenhagen, Denmark; Cecilie Kyro, Nutrition and Biomarkers, The Danish Cancer Society Rsch Cntr, Copenhagen, Denmark; Catherine P Bondonno, Health and Med Sciences, Univ of Western Australia, Perth, Australia; Joshua R Lewis, Health and Med Sciences, Univ of Western Australia, Perth, Australia; Kevin D Croft, Health and Med Sciences, Univ of Western Australia, Perth, Australia; Augustin Scalbert, Biomarkers Group, International Agency for Rsch on Cancer, Lyon, France; Gunnar Gislason, Cardiology, Herlev & Gentofte Univ Hosp, Copenhagen, Denmark; Kim Overvad, Public Health, Aarhus Univ, Aarhus, Denmark; Jonathan M Hodgson, Med and Health Sciences, Edith Cowan Univ, Perth, Australia Abstract Introduction: There is increasing evidence that flavonoids, bioactive plant compounds, reduce cardiovascular disease risk.Methods: In 53 126 participants of the Danish Diet, Cancer and Health Study cross-linked with Danish nationwide registries, we examined the association between total and specific flavonoid subclass intake and the risk of cardiovascular disease (CVD) events (ischemic heart disease (IHD), peripheral artery disease (PAD), and ischemic stroke) and all-cause mortality. Flavonoid intake was calculated from baseline food frequency questionnaires using the Phenol-Explorer database and analyzed by quintiles with Cox proportional hazard models.Results: After 23 years of follow-up, 12 154 participants had CVD events and there were 12 639 deaths from all causes. After multivariable adjustments and compared to the lowest quintile of flavonoid intake (〈254.6 mg/d), participants in the highest quintile (〉914.6 mg/d) had a 12% lower risk of CVD [HR (95%CI): 0.88 (0.83, 0.93)], a 9% lower risk of IHD [0.91 (0.84, 0.97)], a 21% lower risk of PAD [0.79 (0.70, 0.88)], a 14% lower risk of a stroke [0.86 (0.77, 0.96)] and a 15% lower risk of all-cause mortality [0.85 (0.80, 0.90)]. Specifically, the flavonol, flavan-3-ol, proanthocyanidin and theaflavin subclasses were associated with a lower risk of all outcomes. The inverse associations observed were strongest in those with at least one lifestyle risk factor for CVD, in particular, those who smoked or consumed 〉30g/d of alcohol (p interaction〈0.01) and were weakest in women and those with hypertension (p interaction〈0.01).Conclusions: To our knowledge, this is the largest cohort study on flavonoid intake and CVD. We show that flavonoid intake is associated with lower risk of all outcomes and highlight in which subpopulations these effects are greatest.Figure Legend: Multivariable-adjusted hazard ratios for risk of cardiovascular disease events and all-cause mortality by quintiles of total flavonoid intake.