Dietary flavonoid intake and incident coronary heart disease: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study12

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ABSTRACT

Background: Flavonoids are dietary polyphenolic compounds with a variety of proposed beneficial cardiovascular effects, but rigorous prospective studies that examine the association between flavonoid intake and incident coronary heart disease (CHD) in geographically and racially diverse US samples are limited.

Objective: With the use of the new, expanded USDA flavonoid database, we assessed the association between total flavonoid and flavonoid subclass intakes with incident CHD in a biracial and geographically diverse cohort, as well as effect modification by age, sex, race, and region of residence.

Design: Participants were 16,678 black and white men and women enrolled in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a national prospective cohort study. All participants were without CHD at baseline, and all completed a Block98 food-frequency questionnaire. Flavonoid intakes were estimated from USDA flavonoid databases, which were recently improved to address missing values for cooked foods and to adjust for flavonoid losses due to processing. Incident CHD events were participant reported and adjudicated by experts. Quintiles of flavonoid intake were examined as predictors of incident CHD by using Cox proportional hazards regression to obtain HRs. Tests for trend used the quintile medians.

Results: Over a mean ± SD follow-up of 6.0 ± 1.9 y, 589 CHD events occurred. High flavonoid intake was associated with self-identified white race, exercise, not smoking, more education, and higher income. In models that adjusted for sociodemographic, health behavior, and dietary factors, there was an inverse association between anthocyanidin and proanthocyanidin intakes and incident CHD (HRs for quintile 5 compared with quintile 1—anthocyanidins: 0.71; 95% CI: 0.52, 0.98; P-trend = 0.04; proanthocyanidins: 0.63; 95% CI: 0.47, 0.84; P-trend = 0.02). There was no association between total flavonoid or other flavonoid subclass intakes and incident CHD.

Conclusions: Reported anthocyanidin and proanthocyanidin intakes were inversely associated with incident CHD. There was no significant effect modification by age, sex, race, or region of residence.

Keywords

flavonoids
coronary heart disease
epidemiology
diet
prospective studies
cardiovascular disease

ABBREVIATIONS

CD40
cluster of differentiation 40
CHD
coronary heart disease
FFQ
food-frequency questionnaire
FNDDS
Food and Nutrient Database for Dietary Studies
HRQ5vQ1
HR for quintile 5 compared with quintile 1
MI
myocardial infarction
NHS II
Nurses’ Health Study II
REGARDS
REasons for Geographic and Racial Differences in Stroke
VCAM-1
vascular cell adhesion molecule 1

Cited by (0)

1

Supported by cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke; R01 HL080477, K24 HL111154, and K24 HL077506 from the National Heart, Lung, and Blood Institute; and F31 AG048719 from the National Institute on Aging, NIH, Department of Health and Human Services.

2

Supplemental Tables 14 are available from the “Online Supporting Material” link in the online posting of the article and from the same link in the online table of contents at http://ajcn.nutrition.org.