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Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease
Open accessAbstract
Objectives In patients with coronary artery disease (CAD) medically managed according to currently accepted guidelines, we tested whether a 1-month dietary intervention with flavanol-containing cocoa leads to an improvement of endothelial dysfunction and whether this is associated with an enhanced number and function of circulating angiogenic cells (CACs).Background Dietary flavanols can improve endothelial dysfunction. The CACs, also termed endothelial progenitor cells, are critical for vascular repair and maintenance of endothelial function.Methods In a randomized, controlled, double-masked, cross-over trial, 16 CAD patients (64+/-3 years of age) received a dietary high-flavanol intervention (HiFI [375 mg]) and a macronutrient- and micronutrient-matched low-flavanol intervention (LoFI [9 mg]) twice daily in random order over 30 days.Results Endothelium-dependent vasomotor function, as measured by flow-mediated vasodilation of the brachial artery, improved by 47% in the HiFI period compared with the LoFI period. After HiFI, the number of CD34+/KDR+-CACs, as measured by flow cytometry, increased 2.2-fold as compared with after LoFI. The CAC functions, as measured by the capacity to survive, differentiate, proliferate, and to migrate were not different between the groups. The HiFI led to a decrease in systolic blood pressure (mean change over LoFI: -4.2+/-2.7 mm Hg), and increase in plasma nitrite level (mean change over LoFI: 74+/-32 nM). Applying a mixed-effects linear regression model, the results demonstrated a significant increase in flow-mediated vasodilation and a decrease in systolic blood pressure with increasing levels of CD34+/KDR+-CACs.Conclusions Sustained improvements in endothelial dysfunction by regular dietary intake of flavanols are associated with mobilization of functional CACs. (Effect of Cocoa Flavanols on Vascular Function in Optimally Treated Coronary Artery Disease Patients: Interaction Between Endothelial Progenitor Cells, Reactivity of Micro- and Macrocirculation; NCT00553774).
Checked 2026-10-06 · 4 references not checked yet
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Written from the paper’s full text.
TL;DR
In a 30-day randomized crossover trial in 16 medically managed coronary artery disease patients, high-flavanol cocoa improved endothelial function and increased circulating angiogenic cells compared with low-flavanol cocoa. The improvement in flow-mediated dilation and systolic blood pressure tracked with CD34+/KDR+ circulating angiogenic cell mobilization.
Key findings
- Flow-mediated dilation improved by 47% during the high-flavanol period compared with the low-flavanol period; baseline values were 4.4 ± 0.5% and 4.6 ± 0.5% before the low- and high-flavanol regimens, respectively.
- CD34+/KDR+ circulating angiogenic cells increased 2.2-fold after high-flavanol intake versus low-flavanol intake, while assays of survival, differentiation, proliferation, and migration did not differ between groups.
- Systolic blood pressure decreased with high-flavanol intake, reported as a mean change over low-flavanol of −4.2 ± 2.7 mm Hg in the abstract and as a 4.2 ± 0.3 mm Hg decrease in the results; plasma nitrite increased by a mean change over low-flavanol of 74 ± 32 nM.
- In mixed-effects linear regression, each 1% increase in CD34+/KDR+ circulating angiogenic cells was associated with a 4.6% increase in flow-mediated dilation, a 0.52 decrease in brachial artery diameter, and a 4.44 mm Hg decrease in systolic blood pressure.
Methods
- Randomized, controlled, double-masked crossover design: 16 CAD patients (64 ± 3 years; 13 male/3 female) completed the study, receiving high-flavanol cocoa (375 mg) or matched low-flavanol cocoa (9 mg) twice daily for 30 days, with a 1-week washout between interventions.
- Primary and secondary outcomes were brachial artery flow-mediated dilation and circulating angiogenic cell number/function; cells were measured by flow cytometry for CD34/KDR and CD133/KDR and functionally assessed after ex vivo expansion. Tertiary outcomes included plasma nitrite/nitrate, blood pressure, heart rate, and cytokines involved in cell mobilization (VEGF, SDF-1α, SCF).
- Analysis used two-way repeated-measures ANOVA with Holm-Sidak post hoc tests, plus random-effects linear regression to test associations between CD34+/KDR+ circulating angiogenic cells and outcomes.
Limitations
- The paper states that the mechanisms underlying the blood pressure effect cannot be determined from this study and that long-term intervention trials are needed; it also notes that small increases after the low-flavanol regimen may reflect non-flavanol bioactives such as methylxanthines or regression to the mean.
- Evident from the text: the sample was small (16 completers, mostly male), the intervention periods were short (30 days), and no clinical event outcomes were assessed, limiting generalizability and inference about long-term cardiovascular benefit.
- Evident from the text: the study received an unrestricted research grant from Mars, Inc., a coauthor was employed by Mars, Inc., and the company supplied the cocoa beverage powders, indicating a potential conflict of interest.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For each 1% increase in CD34 ϩ /KDR ϩ -CAC numbers, there was a significant increase in FMD of 4.6%, and significant decrease in BA diameter and SBP by 0.52 and 4.44 mm Hg, respectively.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Composition of Matched Flavanol-Containing Test Materials Ingested Twice Daily
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The HiFI led to a decrease in systolic blood pressure (mean change over LoFI: Ϫ4.2 Ϯ 2.7 mm Hg)”
- Also stated in: § Composition of Matched Flavanol-Containing Test Materials Ingested Twice Daily · plain
“corresponding to a 4.2 Ϯ 0.3 mm Hg decrease as compared with LoFI.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Results
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Also stated in: § Composition of Matched Flavanol-Containing Test Materials Ingested Twice Daily · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“After HiFI, the number of CD34 ϩ /KDR ϩ -CACs, as measured by flow cytometry, increased 2.2-fold as compared with after LoFI.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The CAC functions, as measured by the capacity to survive, differentiate, proliferate, and to migrate were not different between the groups.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Endothelium-dependent vasomotor function, as measured by flow-mediated vasodilation of the brachial artery, improved by 47% in the HiFI period compared with the LoFI period.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For each 1% increase in CD34 ϩ /KDR ϩ -CAC numbers, there was a significant increase in FMD of 4.6%, and significant decrease in BA diameter and SBP by 0.52 and 4.44 mm Hg, respectively.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Composition of Matched Flavanol-Containing Test Materials Ingested Twice Daily
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For each 1% increase in CD34 ϩ /KDR ϩ -CAC numbers, there was a significant increase in FMD of 4.6%, and significant decrease in BA diameter and SBP by 0.52 and 4.44 mm Hg, respectively.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Composition of Matched Flavanol-Containing Test Materials Ingested Twice Daily
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These outcomes demonstrate that a randomized, controlled dietary flavanol intervention results in improvements in endothelial dysfunction and BP, and that this is associated with the mobilization of functional CACs in patients with CAD.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our data demonstrate that a further increase of endothelial function can be achieved by complementing standard treatments with a flavanol-based dietary intervention.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesWhat the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The average baseline FMD values were 4.4 Ϯ 0.5% and 4.6 Ϯ 0.5% (p ϭ 0.125) before starting the LoFI or HiFI regimen, respectively (Fig. 2).”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Improvement of FMD.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- It may state two separate claims as one. 18
- Probably not a substantial claim. 13
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Notably, during the course of the present study, our patients did not show any signs of augmented inflammation, or increases in the cytokines analyzed (VEGF, SDF-1␣, and SCF).”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Nitrate levels were not significantly affected by either treatment (average at first visit: 23 Ϯ 5 M).”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Improvement of FMD.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We observed no significant changes in plasma VEGF, SDF-1␣, or SCF and clinical laboratory parameters, including C-reactive protein, erythrocyte sedimentation rate, total cholesterol, LDL, high-density lipoprotein, glucose, triglycerides, and blood cell counts.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Improvement of FMD.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Whereas 30-day LoFI did not significantly change systolic blood pressure (SBP [129 Ϯ 1 mm Hg, p ϭ 0.471 vs. day 0]), HiFI significantly decreased SBP to 125 Ϯ 1 mm Hg (p ϭ 0.013 vs. day 0), corresponding to a 4.2 Ϯ 0.3 mm Hg decrease as compared with LoFI.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Composition of Matched Flavanol-Containing Test Materials Ingested Twice Daily
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The cocoa drinks were well tolerated, and none of the patients experienced major adverse events, cardiovascular-specific events, or hospitalization during the study period.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Characteristics of study group.
Strength:plain· not yet calibratedn = 16Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Mean heart rate and diastolic BP were not significantly affected by either treatment.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Composition of Matched Flavanol-Containing Test Materials Ingested Twice Daily
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and increase in plasma nitrite level (mean change over LoFI: 74 Ϯ 32 nM).”
- Also stated in: § Improvement of FMD. · plain
“Levels of plasma nitrite significantly increased after HiFI, but remained unaltered after LoFI (Fig. 4).”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § Improvement of FMD. · plain
In the 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.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Discussion
What the sources say
- Not checked yetcites [11] Balzer, 2008, Sustained benefits in vascular function through flavanol-containing cocoa in medicated diabetic patients a double-masked, randomized, controlled trial, J Am Coll Cardiol source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All individual medications and treatment paradigms, as well as body mass indexes remained unaltered throughout the study.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Characteristics of study group.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The study protocol was approved by the University of California-San Francisco Committee on Human Research, and subjects gave written informed consent.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Study design.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Physiologically, the mobilization of CACs contributes to the repair response after vascular injury (3,4).”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Discussion
What the sources say
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Cocoa drinks (Mars, Inc., McLean, Virginia) were standardized for flavanol content and profile, and closely matched for macronutrient content, micronutrient content, caloric load, and theobromine and caffeine levels.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Flavanol-containing test material.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Randomization and cocoa drink dispensations were performed by the Department of Pharmacology, University of California-San Francisco.Patients and investigators were masked throughout the study with regard to flavanol content of the test drinks.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Study design.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“Functional CAC characterization was performed after ex vivo expansion (8).”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Cell assays.
What the sources say
- Not checked yetcites [8] Heiss, 2005, Impaired progenitor cell activity in age-related endothelial dysfunction, J Am Coll Cardiol source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Brachial artery (BA) FMD was measured by ultrasonography (13-MHz transducer, Sonosite Micromax, Bothell, Washington) in combination with an automated analysis system (Medical Imaging Applications, Iowa City, Iowa) in a 21°C temperature-controlled room after 30 min of supine rest (7).”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Flavanol-containing test material.
What the sources say
- Not checked yetcites [7] Schroeter, 2006, (−)-epicatechin mediates beneficial effects of flavanol-rich cocoa on vascular function in humans, Proc Natl Acad Sci U S A source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Endothelial vasomotor function assessed as flowmediated dilation (FMD), as well as CAC numbers and function were defined as primary and secondary outcomes, respectively.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Study design.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“Several controlled human dietary intervention studies that have utilized flavanol-containing foods and beverages in concert with nutrient-matched, low-flavanol controls have demonstrated flavanol-dependent effects, including the recovery of endothelial function, decreased blood pressure, and reductions in platelet aggregation (2).”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Conclusions
What the sources say
- Not checked yetcites [2] Corti, 2009, Cocoa and cardiovascular health, Circulation source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“using a randomized, double-masked, crossover study design (Fig. 1) with 1 week of wash-out between interventions.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Study design.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These outcomes demonstrate that a randomized, controlled dietary flavanol intervention results in improvements in endothelial dysfunction and BP, and that this is associated with the mobilization of functional CACs in patients with CAD.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The 16 CAD patients studied are representative of CAD patients medically managed according to current guidelines.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“From the 20 patients initially included, 16 patients completed the study and were included in data analyses.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Study design.
Strength:plain· not yet calibratedn = 16Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“we observed an increase in plasma nitrite, which represents both a marker of NO bioavailability and a bioactive NO donor (10).”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Discussion
What the sources say
- Not checked yetcites [10] Lundberg, 2009, Nitrate and nitrite in biology, nutrition and therapeutics, Nat Chem Biol source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“The CAC number in whole blood was measured by flow cytometry as CD34/KDR and CD133/KDR doublepositive cells in the lymphomononuclear cell gate (8).”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Cell assays.
What the sources say
- Not checked yetcites [8] Heiss, 2005, Impaired progenitor cell activity in age-related endothelial dysfunction, J Am Coll Cardiol source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Based on previous data, it seems unlikely that the small flavanol amounts present in LoFI would explain our findings, but the presence in both test drinks of bioactive compounds other than flavanols, for example, methylxanthines, as well as a general regression to the mean may need to be considered in this context.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Discussion
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our data support the concept that dietary flavanols, in addition to improving cardiovascular functions, can facilitate endogenous repair mechanisms that act synergistically with current medical therapy.”
§ Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper relies on this without support.
The 30-day intervention period is sufficient to produce sustained improvements in endothelial function and circulating angiogenic cell mobilization.
“Sustained improvements in endothelial dysfunction by regular dietary intake of flavanols are associated with mobilization of functional CACs.”
The paper relies on this without support.
The 16 CAD patients studied are representative of CAD patients medically managed according to current guidelines.
“The study group consisted of 16 CAD patients having achieved treatment goals in accordance with current AHA/ACC guidelines”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“The current demonstration of significant reductions in both systolic and diastolic blood pressure levels after regular cocoa flavanol consumption is consistent with previous findings obtained both in normotensives and in hypertensive subjects, as well as medicated individuals.17,18,29,30”
In the citing paper
“The associative relation, increased plasma nitrite levels and an increased mobilization of CD34 ϩ /Flk-1 ϩ cells from the bone marrow, has also been observed in patients with coronary artery disease receiving nutrients that increased NO bioavailability.40”
From Dietary nitrate supplementation improves revascularization in chronic ischemia (2012) · cites this paper as [40]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Conflicting uncertainty for the blood-pressure reduction
MajorThe abstract and results report the same 4.2 mm Hg reduction relative to LoFI, but give different uncertainties: 2.7 and 0.3 mm Hg. This difference affects how strongly the reported blood-pressure effect is supported.
“The HiFI led to a decrease in systolic blood pressure (mean change over LoFI: Ϫ4.2 Ϯ 2.7 mm Hg)”
“corresponding to a 4.2 Ϯ 0.3 mm Hg decrease as compared with LoFI.”
Citations
Cites
Smith, S. C., Allen, J. K., Blair, S. N., Bonow, R. O., Brass, L. M., Fonarow, G. C., Grundy, S. M., Hiratzka, L. F., Jones, D. W., Krumholz, H. M., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.174516 · Cited by 2,101
Circulating endothelial progenitor cells and cardiovascular outcomes
Werner, N., Kosiol, S., Schiegl, T., Ahlers, P., Walenta, K., Link, A., Böhm, M., & Nickenig, G. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa043814 · Cited by 2,048
Polyphenols and disease risk in epidemiologic studies
Arts, I. C., & Hollman, P. C. (2005) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/81.1.317s · Cited by 1,916 · cited 1×
“Heiss), and an unrestricted research grant from 2 f flavanol-containing foods and coronary artery disease CAD) mortality (1).”
Background(–)-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-citationSmith, S. C., Allen, J. K., Blair, S. N., Bonow, R. O., Brass, L. M., Fonarow, G. C., Grundy, S. M., Hiratzka, L. F., Jones, D. W., Krumholz, H. M., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.04.026 · Cited by 671
Nitrate and nitrite in biology, nutrition and therapeutics
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Self-citationImpaired progenitor cell activity in age-related endothelial dysfunction
Heiss, C., Keymel, S., Niesler, U., Ziemann, J., Kelm, M., & Kalka, C. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.12.074 · Cited by 573
Cocoa and Cardiovascular Health
Corti, R., Flammer, A. J., Hollenberg, N. K., & Lüscher, T. F. (2009) · Circulation · doi:10.1161/circulationaha.108.827022 · Cited by 424 · cited 2×
“In line ith previous studies (2), we observed a flavanol intakessociated decrease in SBP, and our data extend these ndings by showing that SBP-lowering effects of dietary avanols may complement standard medical BP manageent.”
BackgroundResultEndothelial progenitor cells in cardiovascular disorders
Shantsila, E., Watson, T., & Lip, G. Y. H. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.09.050 · Cited by 413
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The sweet side of dark chocolate for chronic kidney disease patients
Fanton, S., Cardozo, L., Combet, E., Shiels, P. G., Stenvinkel, P., Vieira, I. O., Narciso, H. R., Schmitz, J., & Mafra, D. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.06.039 · Cited by 31
“In toto, these findings indicate that the habitual consumption of dark chocolate seems to have cardioprotective effect in healthy individuals’ due reduction of arterial pressure and improvement of the endothelium function, associated with reduction on oxidative stress (Al Sunni & Latif, 2014; Heiss et al., 2010; Taube…”
BackgroundLiquid Biopsies: Microvesicles in Cardiovascular Disease
Badimón, L., Suades, R., Vilella-Figuerola, A., Crespo, J., Vilahur, G., Escate, R., Padró, T., & Chiva‐Blanch, G. (2019) · Antioxidants and Redox Signaling · doi:10.1089/ars.2019.7922 · Cited by 29
The Role of Omega-3 Polyunsaturated Fatty Acids Supplementation in Childhood: A Review
Ciccone, M. M., Scicchitano, P., Gesualdo, M., Zito, A., Carbonara, S., Ricci, G., Cortese, F., & Giordano, P. (2013) · Recent Advances in Cardiovascular Drug Discovery (Formerly Recent Patents on Cardiovascular Drug Discovery) · doi:10.2174/1574890111308010006 · Cited by 28
“In adulthood, a Mediterranean diet, rich in plant-derived polyphenols, flavanols and walnuts has already demonstrated to improve endothelial function with a subsequent reduction of cardiovascular diseases incidence [89-91].”
BackgroundPlant secondary metabolites as regenerative medicine
Umashankar, D. D. (2020) · The Journal of Phytopharmacology · doi:10.31254/phyto.2020.9410 · Cited by 25
Cocoa, Blood Pressure, and Vascular Function
Sudano, I., Flammer, A. J., Roas, S., Enseleit, F., Ruschitzka, F. T., Corti, R., & Noll, G. (2012) · Current Hypertension Reports · doi:10.1007/s11906-012-0281-8 · Cited by 30
A versatile approach to the regioselective synthesis of diverse (−)-epicatechin-β-d-glucuronides
Mull, E. S., Zandt, M. V., Gołȩbiowski, A., Beckett, R. P., Sharma, P. K., & Schroeter, H. (2012) · Tetrahedron Letters · doi:10.1016/j.tetlet.2012.01.054 · Cited by 25
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Milenković, D., Rodriguez‐Mateos, A., Lucosz, M., Istas, G., Declerck, K., Sansone, R., Deenen, R., Köhrer, K., Corral‐Jara, K. F., Altschmied, J., et al. (2022) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.202100991 · Cited by 23
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“Brachial artery (BA) FMD was measured by ultrasound (10MHz transducer; Vivid I, GE) in combination with an automated analysis system (Brachial Analyzer, Medical Imaging Applications, Iowa City, IO) in a 21 °C temperature-controlled room after 15min of supine rest [2].”
MethodSelf-citationBustamante, S. Z., Tenorio, A. T., & Rojano, B. A. (2015) · Revista Facultad Nacional de Agronomía Medellín · doi:10.15446/rfnam.v68n1.47836 · Cited by 22
“Adicionalmente, se ha observado el mejoramiento en la capacidad vasodilatadora de las arterias braquiales, en pacientes con enfermedad de las arterias coronarias, al suministrarles bebidas de cacao (Keen et al., 2005; Heiss et al., 2010; Jia et al., 2010; Schinella et al., 2010; Cherniack, 2011).”
BackgroundPalma, R. D., Sotto, I., Wood, E. G., Khan, N. Q., Butler, J., Johnston, A., Rothman, M. T., & Corder, R. (2015) · ESC Heart Failure · doi:10.1002/ehf2.12077 · Cited by 22
Bauer, S. R., Ding, E. L., & Smit, L. A. (2011) · Current Cardiovascular Risk Reports · doi:10.1007/s12170-011-0157-5 · Cited by 20
“Four published randomized controlled trials have evaluated the effect of high-flavonoid cocoa supplementation on Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Quantitative Insulin-Sensitivity Check Index (QUICKI) [20, 23, 24, 26].”
BackgroundTreatment of pulmonary arterial hypertension with circulating angiogenic cells
Mirsky, R. S., Jahn, S., Koskenvuo, J. W., Sievers, R. E., Yim, S., Ritner, C., Bernstein, H. S., Angeli, F. S., Boyle, A., Marco, T. D., et al. (2011) · American Journal of Physiology-Lung Cellular and Molecular Physiology · doi:10.1152/ajplung.00215.2010 · Cited by 20
“Cell isolation and characterization was performed as previously described by our group (14, 15, 17).”
BackgroundMethodSelf-citationRautiainen, S., Sesso, H. D., & Manson, J. E. (2017) · Molecular Aspects of Medicine · doi:10.1016/j.mam.2017.12.001 · Cited by 19
Segade, M., Bermejo, R., Monteiro-Silva, F., Paiva‐Martins, F., Gil‐Longo, J., & Campos‐Toimil, M. (2016) · Journal of Functional Foods · doi:10.1016/j.jff.2016.03.024 · Cited by 19
Al-Dashti, Y. A., Holt, R. R., Carson, J. G., Keen, C. L., & Hackman, R. M. (2019) · Journal of Medicinal Food · doi:10.1089/jmf.2018.0209 · Cited by 19
Self-citationPhillips, B. E., Atherton, P. J., Varadhan, K. K., Limb, M. C., Williams, J. P., & Smith, K. (2016) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2015-0543 · Cited by 21
“2005), patientswith coronary artery disease (Heiss et al. 2010), and heart transplant recipients (Flammer et al.”
BackgroundOlivieri, F., Antonicelli, R., Recchioni, R., Mariotti, S., Marcheselli, F., Lisa, R., Spazzafumo, L., Galeazzi, R., Caraceni, D., Testa, R., et al. (2011) · International Journal of Cardiology · doi:10.1016/j.ijcard.2011.06.091 · Cited by 18
Behavioural effects of compounds co-consumed in dietary forms of caffeinated plants
Haskell‐Ramsay, C. F., Dodd, F. L., Wightman, E. L., & Kennedy, D. O. (2013) · Nutrition Research Reviews · doi:10.1017/s0954422413000036 · Cited by 17
“Significant increases in flow-mediated dilation have been demonstrated across a similar range of populations as studied in relation to blood pressure (many of whom suffer from endothelial dysfunction), whether studied chronically over periods of 8 d to 12 weeks((60,62,63,65,70)), or acutely at 2 h post-administration(…”
BackgroundThe assessment of vascular function during dietary intervention trials in human subjects
McCall, D. O., McKinley, M. C., Noad, R., McKeown, P. P., McCance, D. R., Young, I. S., & Woodside, J. V. (2011) · British Journal Of Nutrition · doi:10.1017/s0007114511002996 · Cited by 14
“The potential risks associated with invasive cardiac assessment limit this (25) Overweight or obese men and postmenopausal women (26) Overweight and obese adults High-flavanol cocoa (902mg flavanols/d) Acute and chronic (12 weeks) (27) Healthy adults High-flavonoid dark chocolate bar (213mg procyanidins, 46mg epicatechin…”
Theobroma cacao—An Introduction to the Plant, Its Composition, Uses, and Health Benefits
Vega, C., & Kwik-Uribe, C. L. (2012) · Elsevier eBooks · doi:10.1016/b978-0-9830791-2-5.50005-0 · Cited by 14
Holt, R. R., Barile, D., Wang, S. C., Munafo, J. P., Arvik, T. J., Li, X., Lee, F., Keen, C. L., Tagkopoulos, I., & Schmitz, H. H. (2022) · Journal of Agricultural and Food Chemistry · doi:10.1021/acs.jafc.2c04519 · Cited by 15
Self-citationSomerset, S. M., Graham, L., & Markwell, K. (2013) · e-SPEN Journal · doi:10.1016/j.clnme.2013.02.003 · Cited by 14
Sasaki, A. T., Kawai, E., Watanabe, K., Yamano, E., Oba, C., Nakamura, K., Natsume, M., Mizuno, K., & Watanabe, Y. (2023) · Nutrients · doi:10.3390/nu16010041 · Cited by 13
“Dark chocolate is rich in cacao polyphenols, which contain abundant epicatechins, catechins, and their oligomeric procyanidins, and are associated with the improvement in endothelial vascular function [4–6].”
BackgroundThe Impact of Modern Anti-Diabetic Treatment on Endothelial Progenitor Cells
Altabas, V., Radošević, J. M., Špoljarec, L., Uremović, S., & Bulum, T. (2023) · Biomedicines · doi:10.3390/biomedicines11113051 · Cited by 12
“From a contemporary viewpoint Better EPC (CD34+/VEGFR2+) counts and improved vasomotor function measured by flow-mediated vasodilation on the brachial artery were detected when flavanols were added to the diet of patients with coronary artery disease [85].”
“Endothelial Progenitor Cells” as a Therapeutic Strategy in Cardiovascular Disease
Kränkel, N., Lüscher, T. F., & Landmesser, U. (2011) · Current Vascular Pharmacology · doi:10.2174/157016112798829832 · Cited by 13
“In human CAD patients, intake of flavanol-rich cocoa increased NO production and the abundance of circulating “EPC” and improved endothelial function [161].”
BackgroundSafety evaluation of EvesseTM EPC, an apple polyphenol extract rich in flavan-3-ols
Lina, B. A. R., Reus, A. A., Hasselwander, O., Bui, Q. D., & Tenning, P. (2012) · Food and Chemical Toxicology · doi:10.1016/j.fct.2012.05.013 · Cited by 11
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(-)-Epicatechin metabolites as a GPER ligands: a theoretical perspective
Ávila‐Avilés, R. D., Bahena-Culhuac, E., & Hernández‐Hernández, J. M. (2024) · Molecular Diversity · doi:10.1007/s11030-024-10968-9 · Cited by 9
Xia, X., Li, G., Dong, Q., Wang, J., & Kim, J. E. (2023) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2023.2248506 · Cited by 9
“However, inconsistent results were observed for flavanol-containing cocoa and folic acid supplementation, which did not demonstrate any changes in the number of EPCs (Heiss et al. 2010; van Oostrom et al. 2009).”
Sasaki, A. T., Mizuno, K., Morito, Y., Oba, C., Nakamura, K., Natsume, M., Watanabe, K., Yamano, E., & Watanabe, Y. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e24430 · Cited by 9
“Cacao polyphenols, including epicatechin, catechin, and procyanidins [4], have antioxidant properties [5] and improve endothelial vascular function [6 – 8].”
BackgroundPremature or pathological aging: longevity
Sgarbieri, V. C., & Pacheco, M. T. B. (2017) · Brazilian journal of food technology/Brazilian Journal of Food Technology · doi:10.1590/1981-6723.19416 · Cited by 10
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Murphy, B., Neill, H. R., Magee, N., Rosbotham, E. J., Pourshahidi, L. K., Richardson, P., Pouchieu, C., Gaudout, D., Ray, S., Bresciani, L., et al. (2025) · Food & Function · doi:10.1039/d5fo01106j · Cited by 8
Development of new food products based on phytonutrients
Bule, M. H., Issa, I. A., Khan, F., Shah, M. A., & Niaz, K. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815354-3.00008-3 · Cited by 8
Nassir, C. M. N. C. M., Ghazali, M. M., Hashim, S., Idris, N. S., Yuen, L. S., Hui, W. J., Norman, H. H., Gau, C. H., Jayabalan, N., Na, Y., et al. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.632131 · Cited by 9
“, increase flowmediated dilation, and reduced systolic blood pressure) (335), which helped to reduce proinflammatory, leukocyte adhesion molecules and NF-κβ, platelet aggregation, and an increase in the release of platelet-derived NO (293, 294, 336).”
BackgroundCocoa Polyphenols and Cardiovascular Health
Crozier, S. J., & Hurst, W. J. (2013) · Polyphenols in Human Health and Disease · doi:10.1016/b978-0-12-398456-2.00083-9 · Cited by 8
Clinical Benefits of Cocoa: An Overview
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Secondary Metabolites: Treasure Trove for Future Medicine
Mitra, R., Ghosh, S., Mukherjee, G., & Chowdhury, A. A. (2023) · Reference series in phytochemistry · doi:10.1007/978-3-031-30037-0_11-1 · Cited by 7
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“Subsequently, numerous clinical trials have shown that flavanol-rich cocoa improves vascular endothelial (dys)function in both healthy cohorts [16] and in those with disease [17], purportedly due to, or at least in part, increased nitric oxide synthase activity and thus bioactive nitric oxide [18].”
BackgroundXia, X., Toh, D. W. K., Ng, S. L., Zharkova, O., Poh, K. K., Foo, R., Wang, J., & Kim, J. E. (2021) · Food & Function · doi:10.1039/d1fo02369a · Cited by 7
Effects of Dark Chocolate and Cocoa Products on Endothelial Function: A Meta-Analysis
Petrone, A. B., Gaziano, J., & Djoussé, L. (2013) · Current nutrition reports · doi:10.1007/s13668-013-0058-y · Cited by 7
Polyphenol Consumption and Blood Pressure
Medina‐Remón, A., Tresserra‐Rimbau, A., Valderas-Martínez, P., Estruch, R., & Lamuela-Raventós, R. M. (2013) · Polyphenols in Human Health and Disease · doi:10.1016/b978-0-12-398456-2.00075-x · Cited by 7
Flavonoids as novel neuroprotective nutraceuticals
Latif, R. (2015) · Saudi Journal for Health Sciences · doi:10.4103/2278-0521.151402 · Cited by 7
“[3] There are several factors behind flavonoid‐induced increased cerebral blood flow such as their potential to reduce BP,[35] improve endothelial functions,[36] and inhibit platelet aggregation[37] and inflammatory response.”
BackgroundCaiati, C., & Jirillo, E. (2025) · Diseases · doi:10.3390/diseases13070221 · Cited by 6
“In patients with CAD receiving dietary high-flavan-3-ol intervention, an increase in brachial artery FMD and a reduction in SBP were recorded [129].”
Gröne, M., Duse, D. A., Kramser, N., Ophoff, N., Schweers, H., Voß, F., Quast, C., Sansone, R., Heiß, C., Jung, C., et al. (2023) · Food & Function · doi:10.1039/d3fo01737k · Cited by 6
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Vascular and Platelet Effects of Cocoa
Sudano, I., Flammer, A. J., Noll, G., & Corti, R. (2012) · Springer eBooks · doi:10.1007/978-88-470-2038-2_8 · Cited by 6
Anti-Stress Activity of Phloroglucinol: A Transient Metabolite of Some Plant Polyphenolics
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Total Hip Replacement Provokes Endothelial Dysfunction
Poredoš, P., Mavric, A., Leben, L., Poredoš, P., & Jezovnik, M. K. (2018) · Angiology · doi:10.1177/0003319718774660 · Cited by 6
Trinquet, N. M., Kellow, N. J., Eviana, R., Williamson, G., & Dordevic, A. L. (2025) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2025.09.020 · Cited by 5
Benefits of Taurisolo in Diabetic Patients with Peripheral Artery Disease
Amato, B., Novellino, E., Morlando, D., Vanoli, C., Vanoli, E., Ferrara, F., Difruscolo, R., Goffredo, V. M., Compagna, R., Tenore, G. C., et al. (2024) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd11060174 · Cited by 5
“Moreover, polyphenols exert a protective action on endothelial cells and on circulating angiogenic cells [12,13].”
BackgroundProtein engineering to develop a redox insensitive endothelial nitric oxide synthase
Rafikov, R., Kumar, S., Aggarwal, S., Pardo, D., Fonseca, F. V., Ransom, J., Rafikova, O., Chen, Q., Springer, M. L., & Black, S. M. (2014) · Redox Biology · doi:10.1016/j.redox.2013.12.015 · Cited by 5
“The therapeutic effects of CACs can be augmented by transducing them to express vascular regulators, such as VEGF and eNOS [26,36,37].”
BackgroundInfluentialSelf-citationVascular Growth Factors, Progenitor Cells, and Angiogenesis
Gowdak, L. H. W., & Krieger, J. E. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-812348-5.00005-2 · Cited by 5
Dried Pears: Phytochemicals and Potential Health Effects
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Self-citationAl-Ogaili, N. A., Al-Jaboury, I. S., & Hasan, Z. Y. M. (2023) · Research Journal of Pharmacy and Technology · doi:10.52711/0974-360x.2023.00052 · Cited by 4
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Secondary Metabolites: Treasure Trove for Future Medicine
Mitra, R., Ghosh, S., Mukherjee, G., & Chowdhury, A. A. (2025) · Reference series in phytochemistry · doi:10.1007/978-3-031-51158-5_11 · Cited by 4
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Effect of fermentation on the antioxidant activity of different Colombian cocoa clones
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Cocoa Flavanol Supplementation and Risk of Age-Related Macular Degeneration
Christen, W. G., Rist, P. M., Moorthy, M. V., Smith, D. C., Holman, B., Clar, A., Glynn, R. J., Mares, J. A., Sobrin, L., Shadyab, A. H., et al. (2025) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2025.0353 · Cited by 3
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Cocoa and chocolate, their clinical benefits:Insights in study design
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Authorised EU health claim for cocoa flavanols
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Dark Chocolate and (Pre-)Hypertension
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Food and Health Forum meeting – nutritional approaches to cardiovascular health: workshop report
Mitchell, H. L., Gibbins, J. M., Griffin, B. A., Lovegrove, J. A., Stowell, J. D., & FOOT, E. A. (2012) · Nutrition Bulletin · doi:10.1111/j.1467-3010.2012.01984.x · Cited by 2
“Improvement of endothelial function with cocoa flavonols has also been shown in patients with coronary artery disease (Heiss et al. 2010).”
BackgroundLim, T. K. (2011) · Springer eBooks · doi:10.1007/978-94-007-2534-8_30 · Cited by 3
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“platelet aggregation and activation, and the modulation of inflammatory and oxidative reactions [15, 16, 17, 18, 19, 20, 21, 22, 23], all factors which can reduce the risks of CAD.”
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Cocoa, Blood Flow and the Brain
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The Effects of Dark Chocolate on Cognitive Performance During Cognitively Demanding TasksPreprint
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Dietary Flavonoids as Modulators of NO Bioavailability in Acute and Chronic Cardiovascular Diseases
Totzeck, M., Kelm, M., & Rassaf, T. (2011) · Humana Press eBooks · doi:10.1007/978-1-60761-616-0_8
“Among all polyphenols, the flavonoid sub-group has been avidly investigated in intervention trials, which demonstrated that the intake of high amounts of flavonoids is inversely related to endothelial dysfunction [1–5].”
BackgroundSelf-citationBénéfices cardiovasculaires du cacao et du chocolat
Lecerf, J. (2013) · Phytothérapie · doi:10.1007/s10298-013-0764-z
Mogollon, J. A. (2012) · Corpus Université Laval (Université Laval)
Chocolate and Coronary Heart Disease
Janszky, I., & Mukamal, K. J. (2012) · Humana Press eBooks · doi:10.1007/978-1-61779-803-0_22
SPOTLIGHT REVIEW Mobilization of stem and progenitor cells in cardiovascular diseases
Wojakowski, W., Landmesser, U., Bachowski, R., Jadczyk, T., & Tendera, M. (2012)
Nutraceuticals Supporting Heart Function in Heart Failure
Cicero, A. F. G., & Colletti, A. (2021) · Contemporary cardiology · doi:10.1007/978-3-030-62632-7_11
(2011) · Journal of Nutrition · doi:10.3945/jn.111.152470
Dietary Flavonoids as Modulators of NO Bioavailability in Acute and Chronic Cardiovascular Diseases
Totzeck, M., & Rassaf, T. (2017) · Springer eBooks · doi:10.1007/978-3-319-46189-2_10
Self-citationMayorga-Gross, A. L., & Montoya‐Arroyo, A. (2023) · Elsevier eBooks · doi:10.1016/b978-0-12-823811-0.00009-2
Gröne, M., Duse, D. A., Kramser, N., Ophoff, N., Schweers, H., Voß, F., Quast, C., Sansone, R., Heiß, C., Jung, C., et al. (2023) · medRxiv · doi:10.1101/2023.04.25.23289076
“These findings corroborate our previous findings that not only in diseased but also in healthy individuals, CFs improve vascular function and cardiovascular risk markers (15, 40, 41).”
ResultBioactive compounds in neglected and underutilized plants
de Souza, T. C. L. (2019) · doi:10.47749/t/unicamp.2019.1162242
Valorización de lías de vino como ingredientes antihipertensivos
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Zhong, R., Guo, Y., You, X., Fu, J., Liu, J., Wen, Y., Wen, J., & Zhao, C. (2026) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.70569
Dey, A., Gautam, M. K., Modak, K., Dutta, P. P., & Mahajon, B. (2026) · Molecular Biology Reports · doi:10.1007/s11033-026-12914-4
Metadata
- Authors
- Heiss, C., Jahn, S., Taylor, M., Real, W. M., Angeli, F. S., Wong, M. L., Amabile, N., Prasad, M., Rassaf, T., Ottaviani, J. I., Mihardja, S., Keen, C. L., Springer, M. L., Boyle, A., Grossman, W., Glantz, S. A., Schroeter, H., & Yeghiazarians, Y.
- Affiliations
- University of California, San Francisco (US)
- Heinrich Heine University Düsseldorf (DE)
- University of California, Davis (US)
- Mars (United States) (US)
- Corresponding author
- Heiss, Christian
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2010-07
- Volume
- 56
- Issue
- 3
- Pages
- 218-224
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2046356569
- Cited by
- 202
- References
- 12
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 8 · 2023: 13 · 2022: 4 · 2021: 7 · 2020: 6 · 2019: 9 · 2018: 13 · 2017: 9 · 2016: 15 · 2015: 19 · 2014: 10 · 2013: 17 · 2012: 32
- FWCI
- 16.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- Mars, Inc.
- Mars Inc.
- N30 Pharmaceuticals
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Biochemistry (medical) › Phytochemicals and Antioxidant Activities
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- flavan-3-ols, Theobroma cacao, endothelial dysfunction, circulating angiogenic cells, endothelial progenitor cells, coronary artery disease, flow-mediated dilation, CD34+/KDR+ cells, systolic blood pressure, plasma nitrite, dietary intervention, vascular function
- MeSH terms
- Blood Pressure, Cacao, Coronary Disease, Diet, Double-Blind Method, Endothelium, Vascular, Female, Flavonoids, Humans, Male, Middle Aged, Vasodilation, Neovascularization, Physiologic, Endothelial Cells
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