ABSTRACT
Cardiovascular disease (CVD) is the number one cause of death worldwide. An estimated 17.3 million people died from CVD in 2008, representing 30% of all global deaths according to the World Health Organization (WHO). Of these deaths, an estimated 7.3 million were thought to be due to coronary heart disease (CHD) and 6.2 million were due to stroke (WHO 2011). Despite aggressive management of CVD risk factors and improved outcomes through pharmaceutical and medical research, the societal burden from CVD remains high. The number of annual CVD-related
6.1 Introduction .................................................................................................. 165 6.2 Risk Factors for CVD and the Role of Oxidative Stress .............................. 166 6.3 Dietary Anthocyanins and CVD Risk: Epidemiological Evidence .............. 167 6.4 Effects of Anthocyanin Chemistry on CVD Biomarkers ............................. 169 6.5 Randomized Controlled Trials of Puried Anthocyanins ............................ 170 6.6 Randomized Controlled Trials of Anthocyanin-Rich Extracts and Foods .. 170
6.6.1 Studies Involving Subjects with Elevated CVD Risk Biomarkers ... 170 6.6.2 Studies with Healthy Subjects .......................................................... 174
6.7 Mechanisms by Which Anthocyanins Inuence the Cardiovascular System ................................................................................. 174
6.7.1 Direct Scavenging Effects ................................................................ 180 6.7.2 Inhibition of ROS-Forming Enzymes .............................................. 182 6.7.3 Decrease in Expression of Inammatory Signaling Molecules ....... 184
6.7.3.1 Cyclooxygenases ................................................................ 184 6.7.3.2 Nitric Oxide ....................................................................... 184
6.7.4 Vasodilatory Action .......................................................................... 185 6.7.5 Platelet Aggregation.......................................................................... 187 6.7.6 Adhesion Molecules, Cytokines, and Chemokines .......................... 188
6.8 Conclusion and Future Research Focus ........................................................ 190 References .............................................................................................................. 190
deaths is on the rise, particularly in lower-income countries, and is expected to reach 23.6 million people per year by 2030 (WHO 2011). Throughout the past decade, there has been increased interest in lifestyle and dietary approaches to reducing cardiovascular risk. Consumption of colorful fruits and vegetables has been inversely associated with a decreased risk of CVD (Nöthlings et al. 2008), most likely due to the abundance and variety of bioactive compounds present. Interest in the biochemistry and biological effects of anthocyanins, as well as their breakdown and/or metabolic products, has substantially increased because of growing evidence that supports potential preventative and therapeutic effects of these compounds toward the onset and progression of CVD. It is widely accepted that the preventive and therapeutic activities of anthocyanins involve modulation of multiple pathways that are crucial to the pathogenesis of CVD. This chapter seeks to assemble the totality of current evidence related to the CVD preventative and therapeutic activities of anthocyanins from in vitro cell culture studies to randomized controlled trials, all contributing to a greater body of scientic knowledge that collectively supports the concept that anthocyanins may exert signicant effects toward long-term cardiovascular health and homeostasis.
