Sustained Benefits in Vascular Function Through Flavanol-Containing Cocoa in Medicated Diabetic Patients
Open accessAbstract
Objectives Our goal was to test feasibility and efficacy of a dietary intervention based on daily intake of flavanol-containing cocoa for improving vascular function of medicated diabetic patients.Background Even in fully medicated diabetic patients, overall prognosis is unfavorable due to deteriorated cardiovascular function. Based on epidemiological data, diets rich in flavanols are associated with a reduced cardiovascular risk.Methods In a feasibility study with 10 diabetic patients, we assessed vascular function as flow-mediated dilation (FMD) of the brachial artery, plasma levels of flavanol metabolites, and tolerability after an acute, single-dose ingestion of cocoa, containing increasing concentrations of flavanols (75, 371, and 963 mg). In a subsequent efficacy study, changes in vascular function in 41 medicated diabetic patients were assessed after a 30-day, thrice-daily dietary intervention with either flavanol-rich cocoa (321 mg flavanols per dose) or a nutrient-matched control (25 mg flavanols per dose). Both studies were undertaken in a randomized, double-masked fashion. Primary and secondary outcome measures included changes in FMD and plasma flavanol metabolites, respectively.Results A single ingestion of flavanol-containing cocoa was dose-dependently associated with significant acute increases in circulating flavanols and FMD (at 2 h: from 3.7 +/- 0.2% to 5.5 +/- 0.4%, p < 0.001). A 30-day, thrice-daily consumption of flavanol-containing cocoa increased baseline FMD by 30% (p < 0.0001), while acute increases of FMD upon ingestion of flavanol-containing cocoa continued to be manifest throughout the study. Treatment was well tolerated without evidence of tachyphylaxia. Endothelium-independent responses, blood pressure, heart rate, and glycemic control were unaffected.Conclusions Diets rich in flavanols reverse vascular dysfunction in diabetes, highlighting therapeutic potentials in cardiovascular disease.
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Dietary polyphenols from sources including cocoa and dealcoholized red wine are linked to improved vascular function.
“Dietary interventions have indicated improved vascular function linked to the consumption of polyphenols from different sources, including cocoa and dealcoholized red wine (60, 168, 225, 417, 834).”
From Sources of Vascular Nitric Oxide and Reactive Oxygen Species and Their Regulation (2019) · cites this paper as [60]
Small but significant increases in flow-mediated dilation and CD34+/KDR+ circulating angiogenic cells were observed after the low-flavanol regimen, differing in part from Balzer et al.
“Differing in part from Balzer et al. (11), we observed small but significant increases in FMD and CD34 ϩ / KDR ϩ -CAC after the LoFI regimen.”
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- Authors
- Balzer, J., Rassaf, T., Heiss, C., Kleinbongard, P., Lauer, T., Merx, M., Heussen, N., Gross, H. B., Keen, C. L., Schroeter, H., & Kelm, M.
- Affiliations
- Universitätsklinikum Aachen (DE)
- University of California, Davis (US)
- Corresponding author
- Kelm, Malte
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2008-06
- Volume
- 51
- Issue
- 22
- Pages
- 2141-2149
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2143536568
- Cited by
- 345
- References
- 34
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 12 · 2023: 9 · 2022: 8 · 2021: 11 · 2020: 15 · 2019: 13 · 2018: 25 · 2017: 23 · 2016: 20 · 2015: 27 · 2014: 19 · 2013: 27 · 2012: 42
- FWCI
- 16.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Biochemistry › Phytochemicals and Antioxidant Activities
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Keywords
- flavan-3-ols, Theobroma cacao, vascular function, flow-mediated dilation, diabetes mellitus, endothelial function, dietary intervention, brachial artery, cardiovascular risk, tachyphylaxis, glycemic control
- MeSH terms
- Aged, Aged, 80 and over, Brachial Artery, Cacao, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Double-Blind Method, Endothelium, Vascular, Feasibility Studies, Female, Humans, Male, Middle Aged, Prognosis, Risk Factors, Time Factors, Cross-Over Studies, Flavonols
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