157 - ‘Flavonoid intake and cardiovascular disease mortality in a prospective cohort of US adults’. Am J Clin Nutr. 95:454–64

Background: Flavonoids are plant-based phytochemicals with cardiovascular protective properties. Few studies have comprehensively examined flavonoid classes in relation to cardiovascular disease mortality.

Objective: We examined the association between flavonoid intake and cardiovascular disease (CVD) mortality among participants in a large, prospective US cohort.

Design: In 1999, a total of 38,180 men and 60,289 women in the Cancer Prevention Study II Nutrition Cohort with a mean age of 70 and 69 y, respectively, completed questionnaires on medical history and lifestyle behaviors, including a 152-item food-frequency questionnaire. Cox proportional hazards modeling was used to calculate multivariate-adjusted hazard RRs and 95% CIs for associations between total flavonoids, 7 flavonoid classes, and CVD mortality.

Results: During 7 y of follow-up, 1589 CVD deaths in men and 1182 CVD deaths in women occurred. Men and women with total flavonoid intakes in the top (compared with the bottom) quintile had a lower risk of fatal CVD (RR: 0.82; 95% CI: 0.73, 0.92; P-trend = 0.01). Five flavonoid classes—anthocyanidins, flavan-3-ols, flavones, flavonols, and proanthocyanidins—were individually associated with lower risk of fatal CVD (all P-trend , 0.05). In men, total flavonoid intakes were more strongly associated with stroke mor- tality (RR: 0.63; 95% CI: 0.44, 0.89; P-trend = 0.04) than with ischemic heart disease (RR: 0.90; 95% CI: 0.72, 1.13). Many asso- ciations appeared to be nonlinear, with lower risk at intakes above the referent category.