The DOI matches its Crossref record; 34 of the 34 references it cites were found in a registry or an index.
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 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]
In the citing paper
“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.”
Citations
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Flavonoid intake and risk of chronic diseases
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(–)-Epicatechin mediates beneficial effects of flavanol-rich cocoa on vascular function in humans
Schroeter, H., Heiss, C., Balzer, J., Kleinbongard, P., Keen, C. L., Hollenberg, N. K., Sies, H., Kwik-Uribe, C., Schmitz, H. H., & Kelm, M. (2006) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0510168103 · Cited by 1,052
Self-citationFlavonoid intake and cardiovascular disease mortality: a prospective study in postmenopausal women
Mink, P. J., Scrafford, C. G., Barraj, L. M., Harnack, L., Hong, C.-P., Nettleton, J. A., & Jacobs, D. R. (2007) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/85.3.895 · Cited by 945
Concentrations of Proanthocyanidins in Common Foods and Estimations of Normal Consumption
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Self-citationDiagnosis and Classification of Diabetes Mellitus
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Brachial Flow-Mediated Dilation Predicts Incident Cardiovascular Events in Older Adults
Yeboah, J., Crouse, J. R., Hsu, F., Burke, G. L., & Herrington, D. M. (2007) · Circulation · doi:10.1161/circulationaha.106.678276 · Cited by 902
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Del Rio, D., Rodriguez-Mateos, A., Spencer, J. P. E., Tognolini, M., Borges, G., & Crozier, A. (2013) · Antioxidants & Redox Signaling · doi:10.1089/ars.2012.4581 · Cited by 2,601
“With regard to endothelial function, a well-known surrogate marker for vascular health, flavan-3-ol-rich cocoa (176– 963 mg of flavan-3-ol monomers and oligomers), has been shown to acutely improve endothelium-dependent vasodilation assessed by flow-mediated dilation (FMD) via increasing plasma NO bioavailability in h…”
Hooper, L., Kay, C., Abdelhamid, A., Kroon, P. A., Cohn, J. S., Rimm, E. B., & Cassidy, A. (2012) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.111.023457 · Cited by 610
Strategies to increase nitric oxide signalling in cardiovascular disease
Lundberg, J. O., Gladwin, M. T., & Weitzberg, E. (2015) · Nature Reviews Drug Discovery · doi:10.1038/nrd4623 · Cited by 576
Tzounis, X., Rodriguez‐Mateos, A., Vulevic, J., Gibson, G. R., Kwik-Uribe, C. L., & Spencer, J. P. E. (2010) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.110.000075 · Cited by 582
Sources of Vascular Nitric Oxide and Reactive Oxygen Species and Their Regulation
Tejero, J., Shiva, S., & Gladwin, M. T. (2019) · Physiological Reviews · doi:10.1152/physrev.00036.2017 · Cited by 541
Metadata
- 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 (medical) › Phytochemicals and Antioxidant Activities
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Physiology (medical) › 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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