Associations of dietary flavonoids and subclasses with total and cardiovascular mortality among 369,827 older people: The NIH-AARP Diet and Health Study

Background and aims: This study aimed to investigate the associations between flavonoid intake and total and cardiovascular mortality in the older participants from the prospective National Institute of Health-American Association of Retired Persons Diet and Health Study.Methods: We included 369,827 eligible participants (mean age 61.2 symbolscript 5.4 years) who were free of cardiovascular diseases (CVDs), cancers, diabetes, and end-stage renal disease at baseline. Dietary flavonoids and major sub-classes (flavan-3-ols, flavones, anthocyanidins, flavonones, and flavonols) were assessed using a validated food frequency questionnaire.Results: During a median follow-up of 23.5 years, we identified 143,403 deaths, of which 40,660 from CVDs. After adjustment for major confounders, total dietary flavonoids and most flavonoid subclasses were related to significantly lower total mortality (hazard ratios: 0.87-0.94), comparing the highest and lowest quintiles. Be-sides, higher intakes of total flavonoids, flavonols, anthocyanidins, and flavones were consistently associated with lower risks of death from all CVDs (hazard ratios: 0.90-0.93), ischemic heart disease (hazard ratios: 0.89-0.94), cerebrovascular disease (hazard ratios: 0.84-0.89), and peripheral artery disease (hazard ratios: 0.79-0.81). Subgroup analysis revealed that the inverse relationships between dietary flavonoids and total and CVD mortality were more evident in former/current smokers than in never-smokers.Conclusions: In conclusion, high intakes of flavonoids were linked to lower total and CVD mortality among older people. Our results extended the current evidence that frequent consumption of flavonoids could be a practical approach to improving cardiovascular health during aging.