Abstract P236: Association Between Alcohol and Ideal Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis

Introduction: Alcohol intake is associated with cardiovascular disease (CVD), with moderate drinkers having a decreased CVD risk compared to non- and heavy drinkers. However, this association is yet to be examined using the AHA Life’s Simple 7 (LS7) metrics as a proxy for cardiovascular health (CVH). We explored associations between alcohol intake and CVH in a multi-ethnic population. Methods: Our cross-sectional analyses included 6,506 MESA participants, free of CVD, aged 45 to 84 years. The LS7 metrics (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol and blood glucose) were each scored 0-2, with 2 indicating “ideal”, 1 “intermediate” and 0 “poor”. Total LS7 score ranged from 0-14. Alcohol data was obtained from personal history and food frequency questionnaires. Participants were classified as never, former or current drinkers. Current drinkers were categorized as <1 (light), 1-2 (moderate) and >2 (heavy) drinks/day. Multinomial logistic regression models assessed associations between alcohol intake and CVH, adjusted for age, sex, race/ethnicity, education, income and health insurance. Results: Mean (SD) age was 62 (10) years, 53% were women; 20% were never, 24% former and 56% current drinkers. Among current drinkers, 44% had <1, 9% 1-2 and 3% >2 drinks/day. Additionally, 47% had inadequate LS7 scores, 33% average and 20% optimal. Compared to never drinkers, those who drank <1 drink/day were more likely to have average and optimal scores, although most of the associations were not significant. Women with 1-2 drinks/day were more likely than men to have optimal scores. Overall and in men, those who drank >2 drinks/day were less likely to have average or optimal scores. Whites and Hispanics with >2 drinks/day were less likely to have optimal and average scores, respectively (Table). Conclusion: Light alcohol intake tended to show favorable CVH, whereas heavy alcohol intake was unfavorable. For moderate alcohol intake, the associations with CVH varied by sex and race/ethnicity.

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Abstract P315: Is Self-rated Health Associated With Ideal Cardiovascular Health? The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.137.suppl_1.p315 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Olatokunbo I Osibogun ◽

Oluseye Ogunmoroti ◽

Erica S Spatz ◽

Gregory L Burke ◽

Erin D Michos

Keyword(s):

Cardiovascular Health ◽

Reference Group ◽

Multinomial Logistic Regression ◽

Heart Association ◽

Cross Sectional ◽

Ethnic Study ◽

Ideal Cardiovascular Health ◽

Health Insurance Status ◽

Self Rated Health ◽

Race Ethnicity

Introduction: Self-rated health (SRH) is a commonly used indicator of health status. It has been identified as a determinant of health-promoting behaviors and a predictor of morbidity and mortality. However, little is known about the association between SRH and ideal cardiovascular health (CVH) as measured by the American Heart Association Life’s Simple 7 (LS7) criteria. We examined whether SRH was associated with ideal CVH, for the overall cohort and by sex and race/ethnicity. Methods: We conducted a cross-sectional analysis of 6457 men and women of 4 race/ethnicities, aged 45 to 84 years, who participated in the Multi-Ethnic Study of Atherosclerosis. SRH was measured on a 5-point Likert scale (excellent, very good, good, fair and poor). CVH was determined using the LS7 score with each of the 7 metrics scored from 0-2, and a total score ranging from 0-14. Scores of 0-8 indicate an inadequate score, 9-10, average and 11-14, optimal. Odds ratios (OR) and 95% confidence intervals were calculated for the associations between SRH and LS7 score categories using multinomial logistic regression, adjusted for age, sex, race/ethnicity, education, income, marital status, health insurance status and chronic diseases Results: The mean age (SD) of participants was 62 (10) years; 53% were women. Approximately, 16% of participants rated their health as excellent, 33% very good, 41% good and 9% poor-fair. In this population, 47% had inadequate LS7 scores, 33%, average and 20% optimal. The odds of having a higher LS7 score increased as SRH improved. Using participants who rated their health as poor-fair as the reference group, the adjusted OR for having an optimal LS7 score in the overall cohort was: excellent 3.0 (2.1-4.3); very good 1.6 (1.1-2.1); good 1.2 (0.9-1.7). A similar trend was observed in the stratified analyses by sex and race/ethnicity ( Table ) Conclusion: A more favorable SRH was associated with better CVH irrespective of sex or race/ethnicity. Further research could explore whether optimization of SRH predicts cardiovascular outcomes.

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Abstract P113: The Probability of Maintaining Ideal Levels of Glucose in US Populations: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and the National Health and Nutrition Examination Survey (NHANES)

Circulation ◽

10.1161/circ.129.suppl_1.p113 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Christy L Avery ◽

Donglin Zeng ◽

Sujatro Chakladar ◽

Katelyn M Holliday ◽

Dan Yu Lin ◽

...

Keyword(s):

Ethnic Groups ◽

Cardiovascular Health ◽

Markov Models ◽

Fasting Glucose ◽

Heart Association ◽

Health Study ◽

Cross Sectional ◽

Ideal Cardiovascular Health ◽

Glucose Levels ◽

Race Ethnicity

Ideal cardiovascular health is a novel concept adopted by the American Heart Association (AHA) that is operationalized through measurement and classification (ideal; intermediate; poor) of seven health metrics, including fasting glucose. Declines in the prevalence of ideal fasting glucose levels have been consistently associated with higher rates of cardiovascular disease, yet few studies have examined the ages at which such declines begin. We used cross-sectional data from NHANES (2007-2010, n=5,961) and the HCHS/SOL (n=14,357) to estimate the age-specific prevalence of ideal (<100 mg/dl without medication), intermediate (100-125 mg/dl or treated to <100 mg/dl) and poor (≥126 mg/dl) fasting glucose levels defined per AHA criteria among European American (EA), African American (AA), and Hispanic/Latino (H/L) participants ≥16 years of age. Race/ethnicity-stratified age-specific net probabilities of transitioning between ideal, intermediate and poor glucose levels were then calculated from cross-sectional estimates using state-of-the-art Markov models that accommodated complex sampling under the assumption that transitions remained stable across time. In all race/ethnic groups, approximately 80% of participants ≤20 years of age had ideal glucose levels. However, the estimated probability of maintaining ideal glucose levels after age 20 varied by race/ethnicity. For example, by the age of 40, the estimated probability of maintaining ideal levels of glucose over the next five years was approximately 90% for EAs and AAs and slightly higher for H/Ls (five-year probability: 92.1%, 95% CI: 91.1%, 93.1%). Among individuals with intermediate glucose levels at age 40, the estimated five-year probability of transitioning to poor levels of glucose was twice as high for AAs (five-year probability: 8.1%, 95% CI: 4.3%, 11.9%) and H/Ls (five-year probability: 9.8%, 95% CI: 8.0%, 11.6%) compared to EAs (five-year probability = 3.9%, 95% CI: 2.7%, 5.3%). Unfortunately, among participants with poor glucose levels, the estimated probability of transitioning to ideal glucose levels remained 0% for all race/ethnic groups and across all ages. Our results suggest that efforts to maintain ideal glucose levels should target young adults and extend through 40 years of age, given the sizeable prevalence of intermediate and poor levels of glucose observed by age 20, the estimated acceleration in the transition to intermediate and poor glucose levels that occurs between the second and fourth decade of life, and the negligible estimated probability of successfully re-attaining ideal glucose levels among those with intermediate or poor glucose levels. Enhanced efforts to identify and treat populations with poor glucose levels also are needed, since these populations would include persons with undiagnosed and therefore untreated type 2 diabetes.

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Abstract P008: Ideal Cardiovascular Health And Hepatocyte Growth Factor In The Multi-ethnic Study Of Atherosclerosis

Circulation ◽

10.1161/circ.143.suppl_1.p008 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Olatokunbo Osibogun ◽

Oluseye Ogunmoroti ◽

Richard A Ferraro ◽

Olumuyiwa A Esuruoso ◽

Chiadi E Ndumele ◽

...

Keyword(s):

Growth Factor ◽

Hepatocyte Growth Factor ◽

Vascular Injury ◽

Cardiovascular Health ◽

Linear Regression Models ◽

Cvd Risk ◽

Ideal Cardiovascular Health ◽

Ideal Metrics ◽

Race Ethnicity ◽

Hepatocyte Growth

Background: Hepatocyte growth factor (HGF) is a cytokine released in response to vascular injury and a novel biomarker of cardiovascular disease (CVD) risk. However, the relationship between ideal cardiovascular health (CVH) and HGF is unknown. We examined whether ideal CVH is associated with lower HGF levels in a multi-ethnic cohort of adults free from clinical CVD at baseline. Methods: We analyzed data from the MESA study of 6,490 men and women aged 45-84 years. The independent variable was the CVH score derived from 7 metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and blood glucose). Each metric was scored 0 points (poor), 1 point (intermediate) and 2 points (ideal). The total CVH score ranged from 0-14. An inadequate score was 0-8, average, 9-10 and optimal, 11-14. The number of ideal metrics was also counted. The dependent variable was logarithmically transformed HGF. We examined the association between the CVH score and HGF using linear regression models adjusted for age, sex, race/ethnicity, education, income, health insurance and study site. Results: The mean (SD) age of participants was 62 (10) years. Fifty-three percent were women. Participants with optimal CVH scores had the lowest HGF concentration [Median (IQR): 807 (678-962) pg/mL] compared to those with average [870 (740-1,036)] and inadequate scores [969 (821-1,159)]. A one-unit increment in the CVH score was significantly associated with a 3% lower HGF concentration (Table). Average and optimal CVH scores were also significantly associated with 8% and 12% lower HGF concentrations, respectively, compared to inadequate scores. Additionally, a greater number of ideal metrics was associated with lower HGF concentrations. Interactions by age, sex and race/ethnicity were not significant. Conclusion: In this ethnically diverse cohort, optimal CVH was significantly associated with lower HGF levels. Interventions aimed at promoting ideal CVH may reduce vascular injury as indicated by lower serum HGF levels.

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Abstract 37: The Association of Cardiorespiratory Fitness and Ideal Cardiovascular Health in the Aerobics Center Longitudinal Study

Circulation ◽

10.1161/circ.135.suppl_1.37 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Leanna M Ross ◽

Jacob L Barber ◽

Xuemei Sui ◽

Steven N Blair ◽

Mark A Sarzynski

Keyword(s):

Longitudinal Study ◽

Cardiorespiratory Fitness ◽

Cardiovascular Health ◽

Smoking Status ◽

Cross Sectional ◽

Ideal Cardiovascular Health ◽

Logistic Regression Models ◽

Using Data ◽

Middle Aged Adults ◽

Aerobics Center Longitudinal Study

Purpose: To examine the cross-sectional association between cardiorespiratory fitness (CRF) and ideal cardiovascular health (CVH) in middle-aged adults. Methods: The association between CRF and ideal CVH score was examined in 11,590 adults (8,865 men, 2,725 women) from the Aerobics Center Longitudinal Study. CRF was measured as duration in minutes from a maximal treadmill test. The AHA’s ideal CVH score was calculated on a 14 point scale using data on smoking status, BMI, physical activity (MET-min/wk), healthy diet, total cholesterol, blood pressure, and fasting plasma glucose recorded between 1987 and 1999. Participants were grouped into categories of inadequate (0-4), average (5-9), and optimum (10-14) based on their CVH score. Three CRF groups were created from age- and sex-specific quintiles based on the previously established cutpoints of treadmill time: low, moderate, and high CRF. We used general linear and logistic regression models adjusted for age, sex, and year of examination to evaluate the association of CRF with ideal CVH score. Results: The mean CVH score for men was 8.4 ± 2.2 and 9.7 ± 2.0 for women. Approximately 33% of men and 57% of women had optimum CVH, while only a small proportion of participants had inadequate CVH (5.1% M, 1.4% F). Treadmill time was moderately correlated (p<0.0001) with CVH score in both men (r=0.56) and women (r=0.50). CRF explained 16% and sex 18% of the variance in CVH score (both p<0.0001). Our adjusted model found that participants in the optimum CVH category had 20% and 43% higher CRF levels than those in the average and inadequate CVH groups (p<0.0001), respectively ( Figure 1 ). The adjusted odds (95% CI) of having optimum CVH were 14.0 (11.0-17.8) and 3.1 (2.4-4.0) times greater for high CRF and moderate CRF, respectively, compared to low CRF (p<0.0001). Discussion: Higher levels of cardiorespiratory fitness are associated with better cardiovascular health profiles in both men and women. Thus, improving fitness represents a strategy to improve cardiovascular and public health.

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Abstract P513: Alcohol Type and Ideal Cardiovascular Health in The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.141.suppl_1.p513 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Oluseye Ogunmoroti ◽

Olatokunbo Osibogun ◽

Robyn L McClelland ◽

Mariana Lazo ◽

Lena Mathews ◽

...

Keyword(s):

Cardiovascular Health ◽

Multinomial Logistic Regression ◽

Heart Association ◽

Prevalence Odds Ratio ◽

Cross Sectional ◽

Lower Odds ◽

Ideal Cardiovascular Health ◽

Study Participants ◽

Sectional Analysis ◽

The Relationship

Background: Light to moderate alcohol consumption is associated with lower incidence of cardiovascular disease (CVD) and favorable cardiovascular health (CVH). However, the association between alcohol type and ideal CVH is yet to be established. This study examined the relationship between alcohol type and ideal CVH as measured by the American Heart Association Life’s Simple 7 (LS7) metrics. Methods: We analyzed data from 6,389 men and women aged 45-84 years from a multi-ethnic cohort free of CVD at baseline. Alcohol type (wine, beer and liquor), assessed from a food frequency questionnaire, was categorized as never, >0 but <1 drink/day, 1-2 drinks/day and >2 drinks/day. Each LS7 metric (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol and blood glucose) was scored 0-2 points, with 2 indicating “ideal”, 1 “intermediate” and 0 “poor”. The maximum CVH score attainable ranged from 0-14 points (inadequate score, 0-8; average, 9-10; optimal, 11-14). We used multinomial logistic regression to examine the association between alcohol type and CVH adjusted for age, sex, race/ethnicity, education, income, health insurance and study site. Results: The mean (SD) age of study participants was 62 (10) years and 53% were women. Participants who consumed 1-2 drinks/day of wine had higher odds of having optimal CVH scores compared to those who never drank wine [prevalence odds ratio (POR) 1.50 (1.02-2.20), Table ]. In comparison to participants who never drank beer, those who consumed 1-2 and >2 drinks/day of beer had lower odds of having optimal scores [POR 0.49 (0.27-0.86) & 0.27 (0.12-0.58), respectively]. Additionally, those who consumed 1-2 and >2 drinks/day of liquor had lower odds of having optimal scores compared to those who never drank liquor [POR 0.52 (0.30-0.89) & 0.28 (0.14-0.55), respectively]. Conclusion: In this cross sectional analysis, moderate consumption of wine was associated with favorable CVH. However, consumption of beer or liquor was associated with poorer CVH.

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Abstract P175: Maintaining Ideal Cardiovascular Health and Freedom From Coronary Artery Calcification

Circulation ◽

10.1161/circ.131.suppl_1.p175 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Shih-Jen Hwang ◽

Oyere Onuma ◽

Joseph M Massaro ◽

Xiaoling Zhang ◽

Yi-Ping Fu ◽

...

Keyword(s):

Logistic Regression ◽

Coronary Artery ◽

Regression Models ◽

Cardiovascular Health ◽

Heart Association ◽

Agatston Score ◽

Cvd Risk ◽

Ideal Cardiovascular Health ◽

Logistic Regression Models

Introduction: Ideal cardiovascular health (CVH), as defined by American Heart Association (AHA), is associated with low levels of cardiovascular disease (CVD) risk factors and freedom from coronary artery calcium (CAC). Hypothesis: Baseline ideal CVH predicts freedom from CAC progression. Methods: In the Framingham Heart Study (FHS), we evaluated prevalence of ideal CVH and investigated associations between ideal CVH and CAC progression. We included 1969 participants who attended the first and second rounds of the FHS Multi-Detector Computed Tomography study (MDCT-I and MDCT-II). The presence and burden of calcification was defined by a modified Agatston score. We calculated the repeatability of two CAC readings performed during MDCT-I and quantified the uncertainty estimate to define CAC progression. At follow-up, an increase in CAC score of 3.4 or higher was defined as positive CAC progression for those free of CAC at baseline. Using criteria modified from the AHA’s Strategic Impact Goal, we defined the prevalence of poor, intermediate and ideal CVH using five of the seven metrics: blood pressure, total-cholesterol, cigarette smoking, body mass index, and fasting glucose. For each metric of CVH, we assigned a score of 0, 1, and 2 points for poor, intermediate, and ideal CVH, respectively, to quantify CVH and extent of change in ideal CVH. Baseline age, baseline CVH status, and change in CVH category were independent variables for logistic regression models to test significant associations between CAC progression and change in ideal CVH. Results: The prevalence of ideal, intermediate, and poor CVH for 1148 participants who were free of baseline CAC were 15.77%, 43.73%, 40.51%, respectively. After an average 6.1 years of follow-up, the prevalence of ideal, intermediate, and poor CVH changed to 6.5%, 43.4%, and 50.1%, respectively, while the CAC progression rates were 8.0%, 13.1%, and 21.6%, respectively. In logistic regression models, there was a non-significant trend for CAC progression by CVH group. Compared to those with poor CVH at baseline, the presence of ideal CVH at baseline was significantly protective against the occurrence of CAC progression; the hazard ratio (HR) for occurrence of CAC progression was 0.36 (95%C.I. 0.19, 0.66, p<0.001). Compared to those with intermediate CVH, there was potential protection against CAC progression, although the HR 0.66 was not statistically significant (95%C.I. 0.36, 1.21, p=0.62). Conclusions: In a community-based study, we observed significant protection from progression of CAC at follow-up for participants who were free of CAC with ideal CVH at baseline. These findings support continued public health measures to promote ideal CVH.

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Abstract P210: The Social Distribution Of Ideal Cardiovascular Health: A Global Systematic Review

Circulation ◽

10.1161/circ.143.suppl_1.p210 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Farah Qureshi ◽

Kelb Bousquet-Santos ◽

Sakurako Shiba ◽

Scott Delaney ◽

Anne-Josee Guimond ◽

...

Keyword(s):

Social Status ◽

Social Determinants ◽

Cardiovascular Health ◽

Risk Of Bias ◽

Cross Sectional ◽

Ideal Cardiovascular Health ◽

The Social ◽

The Us ◽

Race Ethnicity ◽

Social Distribution

Introduction: Numerous studies have examined the social determinants of ideal cardiovascular health (ICVH) around the world, but no work has summarized evidence to date. This study aimed to systematically review findings on the social distribution of ICVH globally, and to compare trends in high-income countries (HICs) vs. low/middle-income countries (LMICs). Methods: In November 2019, we systematically searched PubMed, Embase, and LILACS for observational studies published after the American Heart Association (AHA) defined ICVH as a combination of health factors and behaviors in 2010. Search terms included ICVH/Life’s Simple 7 and a pre-defined set of social determinants of health (i.e., education, income/wealth, socioeconomic status (SES), employment, occupation, and race/ethnicity). Each abstract was reviewed by two independent researchers. Studies were included if associations between a composite measure of ICVH and a social determinant of health was quantified using statistical methods. We evaluated risk of bias using an adapted version of the Newcastle-Ottawa Quality Assessment Scale. Overall findings and comparisons between HICs and LMICs (defined by World Bank guidelines) were summarized narratively. Results: A total of 33 studies met inclusion criteria. Only 8 studies were from LMICs (n=4 from China), while 25 were from HICs (n=19 from the US). The most commonly assessed social determinants were education (n=18) and income/wealth (n=17). In both HICs and LMICs, few studies examined occupation or area-level measures, like rurality/urbanicity. Most studies were cross-sectional (n=27). Two thirds of studies and had a moderate (n=14, 43%) or high (n=8, 24%) risk of bias, but no systematic differences were noted by country setting. Nearly half of studies used composite ICVH measures that were of moderate or poor quality (i.e., based on only self-reported data and/or unvalidated instruments), and only 15% of studies (n=5) assessed each ICVH component using the exact criteria defined by the AHA. Despite substantial heterogeneity in how ICVH measures were derived and analyzed (e.g., as a binary, categorical, or count variable), fairly consistent associations were observed between higher levels of ICVH and higher social status (higher education, income/wealth, racial/ethnic majority status) across both HICs and LMICs. Studies of occupation (n=6, all from HICs) and area-level measures (n=4, 3 from LMICs) were less conclusive. Conclusion: Associations between higher social status and ICVH were noted in both HICs and LMICs, but most evidence was based on correlational data from cross-sectional studies in the US, primarily in relation to education and income. Important gaps in the literature include studies from LMICs, longitudinal designs to improve causal inference, and investigations of occupation, rurality/urbanicity, and race/ethnicity in non-US settings.

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Food insecurity and its association with changes in nutritional habits among adults during the COVID-19 confinement measures in Belgium

Public Health Nutrition ◽

10.1017/s1368980020005005 ◽

2020 ◽

pp. 1-7

Author(s):

Stefanie Vandevijvere ◽

Karin De Ridder ◽

Sabine Drieskens ◽

Rana Charafeddine ◽

Finaba Berete ◽

...

Keyword(s):

Food Insecurity ◽

Multinomial Logistic Regression ◽

Soft Drink ◽

Household Composition ◽

Healthy Diet ◽

Cross Sectional ◽

Nutritional Habits ◽

Logistic Regression Models ◽

Soft Drink Consumption ◽

Snack Consumption

Abstract Objective: To assess food insecurity and its association with changes in nutritional habits among Belgian adults during confinement due to COVID-19. Design: Three cross-sectional online health surveys were conducted during March–May 2020. Multinomial logistic regression models were used to determine associations between self-reported changes in fruit, vegetable, soft drink and sweet and salted snack consumption or weight as dependent variables and food insecurity indicators as independent variables, adjusted for gender, household composition, educational attainment and household income. Setting: Belgium. Participants: In total, 8640 adults recruited by convenience sampling. Results: About 10·4 % of Belgians often or sometimes feared food shortages, 5·0 % were often or sometimes short of food without money to buy more and 10·3 % often or sometimes could not afford to eat a healthy diet during confinement. These percentages were highest among single-parent families (26·7, 14·4 and 23·4 %, respectively). Adults who often or sometimes feared that food would run out during confinement had significantly higher odds of decreased v. unchanged fruits (3·53; 95 % CI = 2·06, 6·05) and vegetables (5·42; 95 % CI = 2·90, 10·11) consumption and significantly higher odds of increased v. unchanged soft drink consumption (3·79; 95 % CI = 2·20, 6·54). Similar results were found for adults who often or sometimes ran out of food and for adults who often or sometimes were not able to afford a healthy diet. Conclusion: Food insecurity during the COVID-19 confinement measures in Belgium was associated with adverse changes in most dietary behaviours. A strong government response is needed to tackle malnutrition and food insecurity to protect public health from ongoing and future pandemics.

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Biomarker-estimated flavan-3-ol intake is associated with lower blood pressure in cross-sectional analysis in EPIC Norfolk

Scientific Reports ◽

10.1038/s41598-020-74863-7 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Javier I. Ottaviani ◽

Abigail Britten ◽

Debora Lucarelli ◽

Robert Luben ◽

Angela A. Mulligan ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Vascular Function ◽

Cardiovascular Health ◽

Vascular Diseases ◽

Inverse Association ◽

Cvd Risk ◽

Lower Systolic Blood Pressure ◽

Cross Sectional ◽

Salt Reduction

Abstract Flavan-3-ols are a group of bioactive compounds that have been shown to improve vascular function in intervention studies. They are therefore of great interest for the development of dietary recommendation for the prevention of cardio-vascular diseases. However, there are currently no reliable data from observational studies, as the high variability in the flavan-3-ol content of food makes it difficult to estimate actual intake without nutritional biomarkers. In this study, we investigated cross-sectional associations between biomarker-estimated flavan-3-ol intake and blood pressure and other CVD risk markers, as well as longitudinal associations with CVD risk in 25,618 participants of the European Prospective Investigation into Cancer (EPIC) Norfolk cohort. High flavan-3-ol intake, achievable as part of an habitual diet, was associated with a significantly lower systolic blood pressure (− 1.9 (− 2.7; − 1.1) mmHg in men and − 2.5 (− 3.3; − 1.8) mmHg in women; lowest vs highest decile of biomarker), comparable to adherence to a Mediterranean Diet or moderate salt reduction. Subgroup analyses showed that hypertensive participants had stronger inverse association between flavan-3-ol biomarker and systolic blood pressure when compared to normotensive participants. Flavanol intake could therefore have a role in the maintenance of cardiovascular health on a population scale.

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