SFRBM Annual Meeting, Pre-meeting Workshop II Flavanols in Health and Disease
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1 FLAVIOLA Targeted delivery of dietary flavanols for optimal human cell function: Effects on cardiovascular health SFRBM Annual Meeting, Pre-meeting Workshop II Flavanols in Health and Disease Flavanol and Procyanidin Intake and Cardiovascular Health: Outcomes from Clinical Intervention Studies Christian Heiss, University of Düsseldorf San Diego, 14 November 2012
2 Flavanol research in humans Do flavanols enhance vascular func3on? Are flavanol effects age- dependent? Can flavanols be protec3ve in CV disease?
3 Causality criteria 1. Vascular effects not abributable to confounders? 2. Flavanols absorbed and transported to vasculature? 3. Dose- responsiveness? Temporality? 4. Pure flavanol mimicking vascular effects? 5. Inhibi3on of mediator pathway abenuates vascular effects? 6. Withholding of flavanols reverses vascular effects?
4 1. Clinical trial standards control confounders Randomized controlled trial (RCT) according to Good Clinical Prac3ce (GCP) Subjects randomized to treatment Tested against placebo control Subjects and inves3gators blinded to alloca3on Relevant groups Sufficiently powered CONsolidated Standards Of Repor3ng Trials* *hbp:// statement.org/
5 1. Clinical trial standards control confounders Use accredited (surrogate) endpoints # Blood pressure Endothelial func3on (FMD) Pulse wave velocity # EFSA Journal 2011
6 2. Monomers, but not oligomers are absorbed and circulate primarily as metabolites DP1-10 DP2-10 DP1 Monomers+Oligomers Monomers Oligomers OBaviani FRBM 2011 OBaviani AJCN 2012
7 3. Dose-dependent improvement of endothelial function following flavanol-rich intervention Heiss JAMA 2003, JACC 2005, JCVP 2007
8 4. Pure (-)-epicatechin acutely improves endothelial function Schroeter PNAS 2006
9 5. Inhibition of NO Synthase by L-NMMA inhibits vascular effects of flavanols Heiss JACC 2005, Schroeter PNAS 2006
10 6. Withholding reverses vascular effects Acute applica3on (975 mg) Repe33ve Applica3on (3x375 mg/d) Time (h) Time (days) Heiss JCVP 2007
11 Flavanol research in humans Do flavanols enhance vascular func3on? Are flavanol effects age- dependent? Can flavanols be protec3ve in CV disease?
12 Age-related vascular changes Flow-mediated dilation (Δ%) Intima Media Thickness (mm) FMD 8 A. p< Young subjects Old subjects Intima media thickness 0.8 A. p< Young subjects Old subjects Nitrite increase (nm) PWV (m/s) Nitrite increase 120 A. p< Young subjects Old subjects Pulse wave velocity 12 A. p< Young subjects Old subjects Heiss JACC 2006, Lauer, Heiss BRC 2008, Keymel BRC 2009
13 Study design: 4-armed randomized controlled double blind parallel group intervention study Inclusion - Healthy, male (YOUNG) (ELDERLY) - BMI kg/m 2 Exclusion - Cardiovascular disease (signs, symptoms, meds) - Diabetes mellitus - Smoking - Acute inflammation - Cardiac arrythmia - Malignancies - Heart failure - Renal failure YOUNG ELDERLY CONTROL (2x0 mg Flavanols) FLAVANOL (2x410 mg) CONTROL (2x0 mg Flavanols) FLAVANOL (2x410 mg) Day Hours after single drink
14 Subject characteristics YOUNG ELDERLY p-value n Age (y) 26 ± 3 60 ± 7 <0.001 BMI (kg/m2) 24.9 ± ± Height (m) 1.83 ± ± Weight (kg) 81 ± ± Creatinine (mg/dl) 1.0 ± ± Total cholesterol (mg/dl) 184 ± ± 32 <0.001 LDL cholesterol (mg/dl) 129 ± ± HDL cholesterol (mg/dl) 53 ± ± Triglycerides (mg/dl) 97 ± ± Fasting plasma glucose (mg/dl) 89 ± 8 95 ± HbA1c (%) 4.8 ± ± SBP (mmhg) 120 ± ± DBP (mmhg) 77 ± 7 82 ± HR (bpm) 56 ± 7 56 ± CRP (mg/dl) 0.1 ± ± Hb (mg/dl) 15.3 ± ± Leucocytes (1000/ul) 5.5 ± ± Smoking history 0 0 Medication 0 0 MV ± SD
15 Flavanols improve age-related impairment in endothelial function YOUNG (18-30) Flavanols Control ELDERLY (50-80) *# *# *# *# *# *# hours hours 1 14 days 1 14 days * p<0.05 vs. 0 h, day 1 baseline, # p<0.05 vs. Control drink, p< 0.05 vs. Young
16 FLAVIOLA Health Study Aims: General applicability, larger population at increased cardiovascular risk, in the context of cardiovascular health, and identify influencing factors Study Design: 2-armed, randomized controlled parallel-group study Sample Size: n=100 Study Population: middle-aged, male, healthy subjects End points 1 Endothelial function 1 month Intervention 2 blood pressure, cholesterol, glucose 3 Exploratory end points» Flavanol intervention 2x410 mg» Flavanol free control
17 Flavanol research in humans Do flavanols enhance vascular func3on? Are flavanol effects age- dependent? ( ) Can flavanols be protec3ve in CV disease?
18 Endothelial homeostasis Injury and Regeneration Endothelial injury & dysfunction Endothelial regeneration NO NO
19 Study design Randomized controlled crossover double blinded trial N=16 Patients with coronary artery disease on optimal medical therapy 30 days high flavanol intervention (2 x 375 mg/d) & low flavanol control (2 x 9 mg/d) 9 mg 375 mg 375 mg 9 mg
20 Flavanol interven3on reverses endothelial dysfunc3on in CAD pa3ents FMD Blood pressure FI high flavanol interven3ons (2x375 mg 30d) C low flavanol control (2x9 mg 30 d) Heiss JACC 2010 * p<0^.05 vs respective pre, # p<0.05 vs C
21 Flavanol intervention mobilizes functional CACs Heiss JACC 2010
22 Flavanol research in humans Do flavanols enhance vascular func3on? Are flavanol effects age- dependent? ( ) Can flavanols be protec3ve in CV disease?
23 Conclusion Clinical interven3on studies Flavanols and their metabolites are vasoac3ve in young, elderly, healthy and diseased humans
24 Conclusion Clinical interven3on studies Flavanols and their metabolites are vasoac3ve in young, elderly, healthy and diseased subjects Perspec.ves Flavanols and their metabolites harbor vasculoprotec3ve poten3al for primary and secondary CVD preven3on
25
26 Take-home Message: Flavanols Session Bioactives rather than (only) Antioxidants Active Compounds: Flavanol Metabolites from Monomer, (-)- Epicatechin; Oligomers (Procyanidins) do NOT contribute Epidemiology: blood pressure lowering in human intervention studies at >50 mg flavanol (monomer)/day
27 Mechanism of Action: prooxidant enzymes, reactive oxygen species (in vitro, cell culture expts); inflammatory markers; master switches: Nrf2, NFkappaB Cardiovascular Health: Flavanols and metabolites vasoactive are vasoactive in young, elderly, healthy and diseased subjects Flavanols and their metabolites harbor vasoprotective potential for primary and secondary CVD prevention
28 FLAVIOLA international workshop on Flavanols in Cardiovascular Health Brussels, 24 January 2012 /project/events/workshop/index.php
SFRBM Annual Meeting, Pre-meeting Workshop II Flavanols in Health and Disease
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