Flavanols and Cardiovascular Disease Prevention

Christian Heiss; Carl L. Keen; Malte Kelm

Disclosures

Eur Heart J. 2010;31(21):2583-2592. 

In This Article

Blood Pressure, Lipids, Glucose Tolerance, and Inflammation

Aside from flavanol-associated effects on conduit artery vasodilation, several studies have shown that there can be effects on blood pressure. Studies by Taubert,[16,67] Grassi,[52,53] and others[17] suggest that in healthy subjects, patients with untreated essential hypertension, and pre-hypertension, blood pressure can be reduced following the consumption of dark chocolate compared with white chocolate. In the study by Taubert et al.,[16] participants with untreated essential hypertension received 6.3 g of dark chocolate per day over 18 weeks, and a significant drop in systolic and diastolic blood pressure was observed. While the results that are reported are provocative, a limitation of this study is that white chocolate was used as a control food product, thus the study was not blinded Furthermore, the different compositions of white and dark chocolate make it difficult to identify specific bioactives, such as flavanols, in the context of blood pressure lowering. We suggest that at present we do not have conclusive data from sufficiently controlled interventional trials to support the notion that flavanols possess antihypertensive properties.

Similar limitations apply to several studies that have reported that the consumption of flavanol-rich foods can result in reductions in LDL cholesterol, and improvements in glucose tolerance.[52,53,68] While these observations are provocative, they need to be confirmed in well-controlled studies. Multiple studies suggest that the acute consumption of flavanol-rich foods/beverages can also result in an inhibition of platelet activity and aggregation,[18,20,69,70] and inhibit monocyte and neutrophil activation in vitro and ex vivo.[71] It has also been reported that the chronic consumption of a high flavanol diet can result in a reduction in select pro-inflammatory markers.[72] While space constraints do not allow for an in-depth review of this literature, these observations support the concept that dietary flavanols have positive vascular effects through a multiplicity of mechanisms. We note that the seemingly diverse actions of flavanols are likely interrelated. Illustrative of this are the observations that an increase in NO can result in a reduction in platelet activation,[18,19,71] as can improvements in glucose tolerance.[73]

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