The Impact of Cocoa Flavanols on Cardiovascular Health

Vlachojannis, Julia; Erné, Paul; Zimmermann, Benno F.; Chrubasik‐Hausmann, Sigrun

doi:10.1002/ptr.5665

Cited by 38 publications

(37 citation statements)

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“…Previously, we have shown that pooling of exploratory studies (Ried et al, 2012) may overestimate the effect size on blood pressure (Vlachojannis, Erne, Zimmermann, & Chrubasik-Hausmann, 2016). This is one reason why we did not pool the data and emphasize as others (Borghi & Cicero, 2017;Cicero et al, 2017) that rigorous studies with a confirmatory design should provide data on the magnitude of blood pressure, blood lipids, and atherosclerosis decrease.…”

Section: Discussionmentioning

confidence: 97%

Preliminary evidence of the clinical effectiveness of odourless garlic

Vlachojannis

Schoenenberger

Erné

et al. 2019

Phytotherapy Research

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This study attempts a systematic evaluation of the clinical evidence for the use of odourless garlic prepared by ageing or fermentation. By PubMed, CENTRAL, and handsearching, 59 clinical studies were identified for potential extraction, of which 24 fulfilled the inclusion criteria. The quality of the studies and evidence of effectiveness were assessed by an established set of conventional criteria. Even the 12 best clinical trials (50%) had fundamental flaws that prevented to grade them as confirmatory. On the basis of a subsample of 19 exploratory studies (79%), an impressive reduction of cardiovascular risk was found for odourless garlic (evidence of effectiveness, “moderate” and for other indications, “poor”). Evidence of effectiveness is further limited by the fact that most studies used aged garlic produced by one pharmaceutical company and that products differed in composition and dose of the marker substance S‐allyl‐cysteine. In case odourless garlic is potentially an effective remedy in particular for cardiovascular diseases, we discern an urgent need for long‐term confirmatory studies. The ultimate cardiovascular endpoint for definitive studies would be mortality, but reductions in blood pressure or demonstrable decreases in atherosclerotic plaques or blood markers of cardiovascular risk would be useful surrogates. Sample sizes for various assumptions are provided.

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Section: Discussionmentioning

confidence: 97%

Preliminary evidence of the clinical effectiveness of odourless garlic

Vlachojannis

Schoenenberger

Erné

et al. 2019

Phytotherapy Research

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“…; Vlachojannis et al . ). In many studies, regular consumption of cocoa, or a flavanol extract of cocoa, reduced blood pressure, blood cholesterol, F2‐isoprostanes and susceptibility of LDL to oxidation.…”

Section: Human Intervention Studies On Flavanols and Flavanol‐rich Fomentioning

confidence: 97%

The role of polyphenols in modern nutrition

2017

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Polyphenols are found in plant‐based foods and beverages, notably apples, berries, citrus fruit, plums, broccoli, cocoa, tea and coffee and many others. There is substantial epidemiological evidence that a diet high in polyphenol‐rich fruit, vegetables, cocoa and beverages protects against developing cardiovascular disease and type 2 diabetes. The absorption and metabolism of these compounds have been well described and, for many, the gut microbiota play a critical role in absorption; taking into consideration the parent compound and the metabolites from colon bacteria catabolism, more than 80% of a dose can be absorbed and ultimately excreted in the urine. Common polyphenols in the diet are flavanols (cocoa, tea, apples, broad beans), flavanones (hesperidin in citrus fruit), hydroxycinnamates (coffee, many fruits), flavonols (quercetin in onions, apples and tea) and anthocyanins (berries). Many intervention studies, mechanistic in vitro data and epidemiological studies support a role for polyphenols against the development of chronic diseases. For example, flavanols decrease endothelial dysfunction, lower blood pressure and cholesterol, and modulate energy metabolism. Coffee and tea both reduce the risk of developing type 2 diabetes, through action of their constituent polyphenols. Despite extensive research, the exact mechanisms of action of polyphenols in the human body have not been decisively proven, but there is strong evidence that some targets such as nitric oxide metabolism, carbohydrate digestion and oxidative enzymes are important for health benefits. Consumption of polyphenols as healthy dietary components is consistent with the advice to eat five or more portions of fruit and vegetables per day, but it is currently difficult to recommend what ‘doses’ of specific polyphenols should be consumed to derive maximum benefit.

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“…(2) We consider that their conclusion-"At present there is no evidence that the doses of cocoa flavanols and epicatechins used in the studies included reliably decrease blood pressure" (Vlachojannis et al, 2016) -is not a reasonable interpretation of the literature. The authors point out the variability of responses in individual studies and note that repeat seated clinic measures of BP are inherently variable and therefore an unreliable means to detect change.…”

Section: Dear Editormentioning

confidence: 98%

“…

Keywords: chocolate; flow mediated dilatation; blood pressure.

Dear editor,We read with interest the recent article by Vlachojannis and colleagues in which they summarised reviews of the effects of cocoa derived flavanols on cardiovascular function (Vlachojannis et al, 2016). We agree that there is a lack of consistency in findings, particularly in relation to blood pressure (BP), and that better reporting of flavanol content in research reports and on consumer products is needed.

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confidence: 99%

Impact of Cocoa Flavanols on Cardiovascular Health: Additional Consideration of Dose and Food Matrix.

Davison

Howe

2016

Phytotherapy Research

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Keywords: chocolate; flow mediated dilatation; blood pressure. Dear editor,We read with interest the recent article by Vlachojannis and colleagues in which they summarised reviews of the effects of cocoa derived flavanols on cardiovascular function (Vlachojannis et al., 2016). We agree that there is a lack of consistency in findings, particularly in relation to blood pressure (BP), and that better reporting of flavanol content in research reports and on consumer products is needed. There are three aspects of their paper that we feel warrant further discussion.(1) Their assertion that the European Food Safety Authority food claim (EFSA Panel on Dietetic Products, Nutrition and Allergies, 2012) needs review because the requisite intake of total flavanol (200 mg/day) is too low is not fully supported by the evidence. The health claim in question relates specifically to circulatory function (as assessed by flow-mediated dilation [FMD]) in healthy (nonpregnant) people; thus, the two studies cited as evidence that the dose is too low (one in pregnant women and one in people with established peripheral vascular disease) are not relevant to the claim (Hammer et al., 2015;Mogollon et al., 2013). Furthermore, the 200-mg intake requirement has been subsequently validated in healthy men and women: 1 week of supplementation with either 80 or 200 mg total flavanol (17 or 42 mg epicatechin, respectively) significantly increased FMD (Grassi et al., 2015). We accept that the optimal dose may be higher than these levels; nevertheless, the 200mg/day intake appears sufficient to support the claimed health benefits.(2) We consider that their conclusion-"At present there is no evidence that the doses of cocoa flavanols and epicatechins used in the studies included reliably decrease blood pressure" (Vlachojannis et al., 2016) -is not a reasonable interpretation of the literature. The authors point out the variability of responses in individual studies and note that repeat seated clinic measures of BP are inherently variable and therefore an unreliable means to detect change. This variability reduces the likelihood of detecting statistically significant effects in individual studies or at the meta-analytic level. In addition to BP measurement techniques, heterogeneity of study designs, sample populations, flavanol doses, and food matrix will also contribute to the variation of outcomes reported in individual studies. Hence, any significant change in BP is more, not less, likely to be a real effect. The main effects reported at the meta-analytic level therefore should be seen as robust indicators of a BP lowering effect with cocoa consumption (Desch et al., 2010;Hooper et al., 2012). (3) The authors also discuss the impact of food matrix with a particular focus on differences in flavanol content in different types of chocolate. What is missing from this discussion is the apparent differential dose response of BP to consuming the flavanols in the form of chocolate or in a flavanol-rich beverage or supplement. We presented data in a recent...

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The Impact of Cocoa Flavanols on Cardiovascular Health

Cited by 38 publications

References 113 publications

Preliminary evidence of the clinical effectiveness of odourless garlic

Preliminary evidence of the clinical effectiveness of odourless garlic

The role of polyphenols in modern nutrition

Impact of Cocoa Flavanols on Cardiovascular Health: Additional Consideration of Dose and Food Matrix.

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