Cocoa flavanols improve symptoms for coronary artery disease

A study published on the Journal of the American College of Cardiology (JACC) found that high concentrations of cocoa flavanols decrease blood pressure, improve the health of blood vessels and increase the number of circulating blood-vessel-forming cells in patients with heart disease. The findings indicate that foods rich in flavanols — such as cocoa products, blueberry, and Ginkgo — have a cardio-protective benefit.

Flavanols are phytonutrient compounds that are found naturally in fruits such as apples, grapes, blueberries, tea, and cherries and herbs such as cocoa nuts and gingko.  The study found a protective effect from a cocoa drink with 375 mg of flavanols, but according to researchers, a standard or recommended dosage has not yet been defined to achieve optimal health benefit.

The UCSF team has shown for the first time that one of the possible mechanisms of flavanol’s benefit is an increase in the circulation of so-called angiogenic cells in the blood. These cells, also known as early endothelial progenitor cells, are critical for the repair process after vascular injury, and perform function and maintenance roles in the endothelium. Endothelium is the thin layer of cells that line the interior wall of blood vessels. Reduced blood vessel function is a hallmark of early development of coronary artery disease. If we can improve the health and function of damaged blood vessels, heart disease patients will have a better chance of survival.

In 2005, researchers reported that an increased level of circulating angiogenic cells is associated with a decreased risk of death from cardiovascular causes (New England Journal of Medicine by Werner, N., et al.) In the current study, the benefit seen from the two-fold increase in circulating angiogenic cells was similar to that achieved by therapy with statins and with lifestyle changes such as exercise and smoking cessation. The benefit demonstrated with cocoa flavanol therapy occurred in addition to the medical regimen already being taken by study participants.

The study included 16 coronary artery disease patients aged 64 years (±three years) who received a high-flavanol cocoa drink (containing 375 mg of flavanols) twice a day over 30 days and then a nutrient-matched low-flavanol cocoa drink (containing 9mg flavanols) twice a day over 30 days. The study was randomized, controlled and “masked,” meaning both the doctors and patients were prevented from knowing which variation of the cocoa drink a patient was drinking at a given time until after the study was completed. The patients continued taking all regular medications for their underlying heart disease during the study period, including statin medications for lowering the cholesterol levels to recommended goals. Researchers calculated the outcome of the cocoa intervention using blood pressure readings, ultrasound to measure dilation of the brachial artery, and cell assays to calculate the number and behavior of circulating angiogenic cells.

The tests showed a 47 percent improvement in vasodilation, or widening rather than constriction, of the brachial artery in the high-flavanol time period compared to the low-flavanol period. In addition, circulating angiogenic cells increased 2.2-fold and systolic blood pressure decreased among the high-flavanol versus low-flavanol periods. The findings demonstrate that a further increase in endothelial function and improvement in blood pressure can be achieved by complementing standard treatment with a flavanol-rich diet.

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Journal Reference: Christian Heiss, Sarah Jahn, Melanie Taylor, Wendy May Real, Franca S. Angeli, Maelene L. Wong, Nicolas Amabile, Megha Prasad, Tienush Rassaf, Javier I. Ottaviani, Shirley Mihardja, Carl L. Keen, Matthew L. Springer, Andrew Boyle, William Grossman, Stanton A. Glantz, Hagen Schroeter, and Yerem Yeghiazarians. Improvement of Endothelial Function With Dietary Flavanols Is Associated With Mobilization of Circulating Angiogenic Cells in Patients With Coronary Artery Disease. J Am. Coll. Cardiol, July 13, 2010; 56: 218-224 DOI: 10.1016/j.jacc.2010.03.039

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