Role Of Flavonoids In Cardiovascular Disease

In addition to alcohol, evidence that dietary flavonoid intake was inversely related to mortality from coronary heart disease has been supported by recent epi-demiologic studies (Knekt et al., 1996; Hertog et al., 1993a, 1995, 1997; Rimm et al., 1996). In the Zutphen Elderly study, Hertog et al. (1993a, 1997) showed that after adjustment for age, weight, certain risk factors of coronary artery disease, and intake of antioxidant vitamins, the highest tertile of flavonoid intake, primarily from tea, onions, and apples, had a relative risk for heart disease of 0.32 compared with the lowest tertile, assigned a relative risk of 1.0. It should be noted that wine was not a significant contributor to flavonoid intake in these studies. At present it is not possible to distinguish from these epidemiologic observations whether the protective effect is related to polyphenols in general, consumption of certain foods high in these compounds, or other dietary components. Thus the evidence supporting a protective effect of polyphenol intake against ischemic heart disease in humans is suggestive, but still inconclusive.

As a group, the polyphenols and in particular flavonoids, have generally been recognized to possess significant antioxidant activities, such as scavenging oxygen free radicals or chelating metals (Salah et al., 1995; Rice-Evans et al., 1996; Cao et al., 1997; Sugihara et al., 1999). It is likely that various polyphenols, including flavonoids, act similar to dietary antioxidants and that collectively they may bestow protection from the development of heart disease. Other polyphenols, such as resveratrol, have been reported to have glutathione sparing mechanisms, at least in vitro (Burkitt and Duncan, 2000). In addition, the functional effectiveness of these compounds in protecting from ischemic or reperfusion injury has been demonstrated

TABLE 4.1

Proposed Properties of Wine or its Polyphenols to Reduce Risk of Atherosclerosis and Heart Disease

  1. General Antioxidant Activity Chelate transition metals Inhibit oxidation of LDL Scavenge oxygen free radicals Maintain plasma antioxidant vitamin levels T Plasma uric acid (?)
  2. Effects on Plasma Lipids I Total cholesterol

T HDL levels l LDL levels I Lipoprotein synthesis I Lipoprotein [a] levels (?)

III. Other Effects

Anticoagulant effects including aspirin-like activity T Nitric oxide synthesis to keep blood vessels patent Other anti-inflammatory activity in various animal models (Canali et al., 2000; Sato et al., 1999, 2000; Hung et al., 2000). Table 4.1 lists the various actions suggested through which polyphenols could impact on the development of CVD.

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