Sustained Benefits in Vascular Function Through Flavanol-Containing Cocoa in Medicated Diabetic Patients. A Double-Masked, Randomized, Controlled Trial

Jan Balzer, Tienush Rassaf, Christian Heiss, Petra Kleinbongard, Thomas Lauer, Marc Merx, Nicole Heussen, Heidrun B. Gross, Carl L Keen, Hagen Schroeter, Malte Kelm

Research output: Contribution to journalArticle

238 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2141-2149
Number of pages9
JournalJournal of the American College of Cardiology
Volume51
Issue number22
DOIs
StatePublished - Jun 3 2008

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Blood Vessels
Dilatation
Randomized Controlled Trials
Eating
Diet
Brachial Artery
Feasibility Studies
Endothelium
Cardiovascular Diseases
Heart Rate
Outcome Assessment (Health Care)
Blood Pressure
Food
Therapeutics

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Sustained Benefits in Vascular Function Through Flavanol-Containing Cocoa in Medicated Diabetic Patients. A Double-Masked, Randomized, Controlled Trial. / Balzer, Jan; Rassaf, Tienush; Heiss, Christian; Kleinbongard, Petra; Lauer, Thomas; Merx, Marc; Heussen, Nicole; Gross, Heidrun B.; Keen, Carl L; Schroeter, Hagen; Kelm, Malte.

In: Journal of the American College of Cardiology, Vol. 51, No. 22, 03.06.2008, p. 2141-2149.

Research output: Contribution to journalArticle

Balzer, J, Rassaf, T, Heiss, C, Kleinbongard, P, Lauer, T, Merx, M, Heussen, N, Gross, HB, Keen, CL, Schroeter, H & Kelm, M 2008, 'Sustained Benefits in Vascular Function Through Flavanol-Containing Cocoa in Medicated Diabetic Patients. A Double-Masked, Randomized, Controlled Trial', Journal of the American College of Cardiology, vol. 51, no. 22, pp. 2141-2149. https://doi.org/10.1016/j.jacc.2008.01.059
Balzer, Jan ; Rassaf, Tienush ; Heiss, Christian ; Kleinbongard, Petra ; Lauer, Thomas ; Merx, Marc ; Heussen, Nicole ; Gross, Heidrun B. ; Keen, Carl L ; Schroeter, Hagen ; Kelm, Malte. / Sustained Benefits in Vascular Function Through Flavanol-Containing Cocoa in Medicated Diabetic Patients. A Double-Masked, Randomized, Controlled Trial. In: Journal of the American College of Cardiology. 2008 ; Vol. 51, No. 22. pp. 2141-2149.
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abstract = "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.",
author = "Jan Balzer and Tienush Rassaf and Christian Heiss and Petra Kleinbongard and Thomas Lauer and Marc Merx and Nicole Heussen and Gross, {Heidrun B.} and Keen, {Carl L} and Hagen Schroeter and Malte Kelm",
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AU - Balzer, Jan

AU - Rassaf, Tienush

AU - Heiss, Christian

AU - Kleinbongard, Petra

AU - Lauer, Thomas

AU - Merx, Marc

AU - Heussen, Nicole

AU - Gross, Heidrun B.

AU - Keen, Carl L

AU - Schroeter, Hagen

AU - Kelm, Malte

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N2 - 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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