Associations between flavonoid intake and subclinical atherosclerosis: The MESA

Authors: BONDONNO, NICOLA - Edith Cowan University (ECU); PARMENTER, BENJAMIN - The University Of Western Australia; MURRAY, KEVIN - The University Of Western Australia; BONDONNO, CATHERINE - Edith Cowan University (ECU); BLEKKENHORST, LAUREN - Edith Cowan University (ECU); WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC); POST, WENDY - Johns Hopkins University School Of Medicine; ALLISON, MATTHEW - University Of California, San Diego; CRIQUI, MICHAEL - University Of California, San Diego; LEWIS, JOSHUA - Edith Cowan University (ECU); HODGSON, JONATHAN - Edith Cowan University (ECU)

Submitted to: Arteriosclerosis Thrombosis and Vascular Biology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/26/2024
Publication Date: 9/12/2024
Citation: Bondonno, N.P., Parmenter, B.H., Murray, K., Bondonno, C.P., Blekkenhorst, L.C., Wood, A.C., Post, W.S., Allison, M., Criqui, M.H., Lewis, J.R., Hodgson, J.M. 2024. Associations between flavonoid intake and subclinical atherosclerosis: The MESA. Arteriosclerosis Thrombosis and Vascular Biology. https://doi.org/10.1161/ATVBAHA.124.321106.
DOI: https://doi.org/10.1161/ATVBAHA.124.321106

Interpretive Summary: A study of over 5,500 older adults looked at how eating flavonoids, which are plant compounds found in fruits and vegetables, affects early signs of atherosclerosis (a condition where arteries become hardened). The research, conducted on data collected over a period of about 10 years, found that people who consumed higher amounts of flavonoids had a lower chance of developing signs of atherosclerosis in their peripheral and carotid arteries. Specifically, those with high flavonoid intake were less likely to have low ankle-brachial index (ABI) readings and carotid plaques, which are indicators of artery health. However, the study didn't find any effects on coronary artery calcification. Overall, the study suggests that eating more flavonoid-rich foods might help protect against some forms of arterial disease, particularly in non-coronary arteries.

Technical Abstract: Flavonoids may play a role in mitigating atherosclerotic cardiovascular diseases, with evidence suggesting effects may differ between vascular beds. Studies examining associations with subclinical markers of atherosclerosis between subpopulations with different underlying risks of atherosclerosis are lacking. Among 5599 participants from the MESA (Multi-Ethnic Study of Atherosclerosis), associations between dietary flavonoid intakes (estimated from a food frequency questionnaire) and subclinical measures of atherosclerosis (ankle-brachial index, carotid plaques and intima-media thickness, and coronary artery calcification) were examined using repeated measures models. Exposures and outcomes were measured at exam 1 (2000–2002) and exam 5 (2010–2011). Stratified analyses and interaction terms were used to explore effect modification by time, sex, race/ethnicity, and smoking status. In the analytic population, at baseline, approximately 46% were males with a median age of 62 (interquartile range, 53–70) years and total flavonoid intakes of 182 (interquartile range, 98–308) mg/d. After multivariable adjustments, participants with the highest (quartile 4) versus lowest (quartile 1) total flavonoid intakes had 26% lower odds of having an ankle-brachial index <1 (odds ratio, 0.74 [95% CI, 0.60–0.92]) and 18% lower odds of having a carotid plaque (odds ratio, 0.82 [95% CI, 0.69–0.99]), averaged over exams 1 and 5. Moderate (quartile 3) to high (quartile 4) intakes of flavonols, flavanol monomers, and anthocyanins were associated with 19% to 34% lower odds of having an ankle-brachial index <1 and 18% to 20% lower odds of having carotid plaque. Participants with the highest intakes of anthocyanins (quartile 4) at baseline had a marginally slower rate of carotid plaque progression than those with moderate intakes (quartiles 2 and 3). There were no significant associations with intima-media thickness or coronary artery calcification. Observed associations did not differ by sex, race/ethnicity, or smoking status. In this multi-ethnic population, higher dietary flavonoid intakes were associated with lower odds of peripheral and carotid artery atherosclerosis. Increasing intakes of healthy, flavonoid-rich foods may protect against atherosclerosis in the peripheral and carotid arteries.