Dietary Flavonoids and Cardiovascular Disease: A Comprehensive Dose–Response Meta-Analysis

Scope: Dietary flavonoids have shown potential in the prevention of noncommunicable diseases. The aim of the present study is to conduct a dose–response meta-analysis on the association between dietary intake of total, subclasses and individual flavonoids and risk of cardiovascular disease (CVD). Methods and Results: Electronic databases are searched. A total of 39 prospective cohort studies are included, comprising 1 501 645 individuals and a total of 33 637 cases of CVD, 23 664 of coronary heart disease (CHD), and 11 860 of stroke. Increasing dietary intake of total flavonoids is linearly associated with a lower risk of CVD. Among the main classes of flavonoids, increasing intake of anthocyanins and flavan-3-ols is inversely associated with risk of CVD, while flavonols and flavones with CHD. Only increasing flavanones showed a linear inverse association with stroke risk. Catechins showed a favorable effect toward all cardiovascular outcomes. Among individual compounds, intake of quercetin and kaempferol is linearly associated with lower risk of CHD and CVD, respectively. However, higher intake of all the aforementioned compounds is associated, with a various extent, with a lower risk of CVD when considering comparison of extreme categories of consumption. Conclusion: The results of this study provide evidence of potential cardiovascular benefits of a flavonoid-rich diet.