A Summary of the article on “High Anthocyanin Intake Is Associated With a Reduced Risk of Myocardial Infarction in Young and Middle-Aged Women”
Background
The article “High Anthocyanin Intake Is Associated With a Reduced Risk of Myocardial Infarction in Young and Middle-Aged Women” by Cassidy et al. (2013) published in Circulation in January 2013, addresses the limited knowledge regarding modifiable risk factors, particularly diet, for preventing myocardial infarction (MI) in younger women. Coronary heart disease (CHD) typically affects older age groups, and risk factors may vary with age, especially in women, where the mechanisms may include coronary vasospasm linked to endothelial dysfunction. Dietary flavonoids, which are bioactive compounds in plant-based foods, have been shown to exert beneficial effects on endothelial function and blood pressure, suggesting they might lower CHD risk in younger women.
Methods
The study was a prospective cohort analysis conducted within the Nurses’ Health Study II (NHSII). The research followed up 93,600 women aged 25 to 42 years who were healthy at baseline (1989). Dietary intake of flavonoid subclasses was calculated using validated food-frequency questionnaires (FFQs) collected every four years. The follow-up period spanned 18 years, during which 405 cases of incident MI were documented.
Results
The main finding was an inverse association between higher intake of anthocyanins and a reduced risk of MI. Anthocyanins are the subclass of flavonoids responsible for the red/blue color of plants and are found in foods such as strawberries and blueberries. After extensive multivariate adjustment for established dietary and non-dietary cardiovascular disease (CVD) risk factors (including smoking, BMI, alcohol, physical activity, and family history of MI), women in the highest quintile of anthocyanin intake showed a 32% reduction in MI risk compared with those in the lowest quintile (Hazard Ratio, 0.68; 95% confidence interval, 0.49–0.96). This inverse association was not significantly weakened even after additionally adjusting for intermediate conditions like a history of hypertension.
Further analysis suggested a continual dose-response at higher levels of habitual intake; comparing the top and bottom 10% of intake resulted in a 47% reduction in MI risk. For every 15-mg increase in anthocyanin intake, the relative risk of MI decreased by 17%. When examining food sources, the combined intake of blueberries and strawberries tended to be associated with a decreased risk of MI (HR, 0.66) in a comparison of those consuming more than three servings per week against those with lower intake. However, intakes of other flavonoid subclasses—including flavan-3-ols, flavonols, and flavanones—were not significantly associated with MI risk after multivariate adjustment.
Conclusions
The findings indicate that high anthocyanin intake may reduce MI risk in predominantly young women. The observed benefits appeared specific to constituents in anthocyanin-rich foods, as adjusting for other potentially beneficial components like potassium, folate, or total fruit and vegetable intake did not substantially weaken the relationship. The authors conclude that further intervention trials are necessary to examine the dose-response effects and the health impact of increasing consumption of commonly eaten anthocyanin-rich foods.
References
Cassidy, A., Mukamal, K. J., Liu, L., Franz, M., Eliassen, A. H., & Rimm, E. B. (2013). High Anthocyanin Intake Is Associated With a Reduced Risk of Myocardial Infarction in Young and Middle-Aged Women. Circulation, 127(2), 188–196. https://doi.org/10.1161/CIRCULATIONAHA.112.122408
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