Objective: The objective was to evaluate the effects of chronic cocoa consumption on cellular and serum biomarkers related to atherosclerosis in high-risk patients.

Design: Forty-two high-risk volunteers (19 men and 23 women; mean ± SD age: 69.7 ± 11.5 y) were included in a randomized crossover feeding trial. All subjects received 40 g cocoa powder with 500 mL skim milk/d (C+M) or only 500 mL skim milk/d (M) for 4 wk. Before and after each intervention period, cellular and serum inflammatory biomarkers related to atherosclerosis were evaluated.

Results: Adherence to the dietary protocol was excellent. No significant changes in the expression of adhesion molecules on T lymphocyte surfaces were found between the C+M and M groups. However, in monocytes, the expression of VLA-4, CD40, and CD36 was significantly lower (P = 0.005, 0.028, and 0.001, respectively) after C+M intake than after M intake. In addition, serum concentrations of the soluble endothelium-derived adhesion molecules P-selectin and intercellular adhesion molecule-1 were significantly lower (both P = 0.007) after C+M intake than after M intake.

Conclusions: These results suggest that the intake of cocoa polyphenols may modulate inflammatory mediators in patients at high risk of cardiovascular disease. These antiinflammatory effects may contribute to the overall benefits of cocoa consumption against atherosclerosis. This trial was registered in the Current Controlled Trials at London, International Standard Randomized Controlled Trial Number, at controlled-trials.com as ISRCTN75176807.

Objective: The purpose of this study was to estimate the association of whole-grain intake (g/d) and risk of incident hypertension in a large prospective cohort of men.

Design: The Health Professionals Follow-Up Study is a prospective cohort consisting of 51,529 male health professionals ranging in age from 40 to 75 y at enrollment in 1986. Baseline and updated measurement of whole-grain intake as well as important covariates were measured, and 31,684 participants without known hypertension, cancer, stroke, or coronary heart disease were followed prospectively for 18 y through 2004 for onset of hypertension.

Results: A total of 9227 cases of incident hypertension were reported over the 18 y of follow-up. In multivariate-adjusted analyses, whole-grain intake was inversely associated with risk of hypertension, with a relative risk (RR) of 0.81 (95% CI: 0.75–0.87) in the highest compared with the lowest quintile (P for trend < 0.0001). In the multivariate model, total bran was inversely associated with hypertension, with a relative risk (RR) of 0.85 (95% CI: 0.78, 0.92) in the highest compared with the lowest quintile (P for trend: 0.002).

Conclusions: In summary, we found an independent inverse association between intake of whole grains and incident hypertension in men. Bran may play an important role in this association. These findings have implications for future dietary guidelines and prevention of hypertension.

Objective: We investigated whether pericardial fat predicts future coronary heart disease events.

Design: We conducted a case-cohort study in 998 individuals, who were randomly selected from 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants and 147 MESA participants (26 from those 998 individuals) who developed incident coronary heart disease from 2000 to 2005. The volume of pericardial fat was determined from cardiac computed tomography at baseline.

Results: The age range of the subjects was 45–84 y (42% men, 45% white, 10% Asian American, 22% African American, and 23% Hispanic). Pericardial fat was positively correlated with both body mass index (correlation coefficient = 0.45, P < 0.0001) and waist circumference (correlation coefficient = 0.57, P < 0.0001). In unadjusted analyses, pericardial fat (relative hazard per 1-SD increment: 1.33; 95% CI: 1.15, 1.54), but not body mass index (1.00; 0.84, 1.18), was associated with the risk of coronary heart disease. Waist circumference (1.14; 0.97, 1.34; P = 0.1) was marginally associated with the risk of coronary heart disease. The relation between pericardial fat and coronary heart disease remained significant after further adjustment for body mass index and other cardiovascular disease risk factors (1.26; 1.01, 1.59). The relation did not differ by sex.

Conclusion: Pericardial fat predicts incident coronary heart disease independent of conventional risk factors, including body mass index.

Objective: We aimed to identify and quantify the effectiveness of flaxseed and its derivatives on blood lipid profiles.

Design: A comprehensive literature search was performed on the basis of English reports of randomized controlled trials of flaxseed or its derivatives on lipid profiles in adults, which were published from January 1990 to October 2008. Attempts also were made to access unpublished data. Study quality was assessed by using the Jadad score, and a meta-analysis was conducted.

Results: Twenty-eight studies were included. Flaxseed interventions reduced total and LDL cholesterol by 0.10 mmol/L (95% CI: –0.20, 0.00 mmol/L) and 0.08 mmol/L (95% CI: –0.16, 0.00 mmol/L), respectively; significant reductions were observed with whole flaxseed (–0.21 and –0.16 mmol/L, respectively) and lignan (–0.28 and –0.16 mmol/L, respectively) supplements but not with flaxseed oil. The cholesterol-lowering effects were more apparent in females (particularly postmenopausal women), individuals with high initial cholesterol concentrations, and studies with higher Jadad scores. No significant changes were found in the concentrations of HDL cholesterol and triglycerides.

Conclusions: Flaxseed significantly reduced circulating total and LDL-cholesterol concentrations, but the changes were dependent on the type of intervention, sex, and initial lipid profiles of the subjects. Further studies are needed to determine the efficiency of flaxseed on lipid profiles in men and premenopausal women and to explore its potential benefits on other cardiometabolic risk factors and prevention of cardiovascular disease.

Objective: The objective was to investigate the effects of water and food plus water intake on brachial and central blood pressure (BP) and measures of arterial stiffness, including augmentation pressure and augmentation index, by using the PWA technique.

Design: Measurements of BP and PWA were made at fasting and for 2 h after the intake of water or breakfast (1300 kJ) in random order in 35 subjects.

Results: Baseline fasting measures of BP and arterial stiffness were not significantly different before the 2 interventions. Consumption of food plus water, compared with water alone, led to a significantly lower (all P < 0.01) brachial diastolic pressure (difference: –3.8 mm Hg), central BP (difference: systolic, –6.1 mm Hg; diastolic, –3.8 mm Hg), central pulse pressure (difference: –2.4 mm Hg), mean arterial pressure (difference: –4.6 mm Hg), augmentation pressure (difference: –2.9 mm Hg), and augmentation index (difference: –5.3 mm Hg).

Conclusions: Markers of central hemodynamics are sensitive to feeding state and therefore should be measured at fasting to avoid variability due to recent (within 2–3 h) food intake. This is especially important when measurements are repeated over time to assess the effect of medication or lifestyle changes on cardiovascular disease risk factors.