Cardioprotection by Cocoa Polyphenols and ω-3 Fatty Acids: A Disease-Prevention Perspective on Aging-Associated Cardiovascular Risk

Sergio Davinelli, Graziamaria Corbi, Stefano Righetti, Barry Sears, Hector Hugo Olarte, Davide Grassi, Giovanni Scapagnini, Sergio Davinelli, Graziamaria Corbi, Stefano Righetti, Barry Sears, Hector Hugo Olarte, Davide Grassi, Giovanni Scapagnini

Abstract

Cardiovascular disease (CVD) remains the leading cause of death today. Many of the biochemical alterations associated with the pathophysiology of CVD can be modified by adequate intakes of bioactive nutrients through a correct diet or supplementation. Recently, there has been growing public and clinical interest in cocoa polyphenols (CPs) and omega-3 (ω-3) fatty acids. A plethora of nutritional intervention trials and experimental studies demonstrates that consumption of these bioactive food compounds is beneficial to promote cardiovascular health. The purpose of this review is to summarize the major cardioprotective effects of CPs and ω-3 fatty acids, providing a scientific rationale for incorporating the combination of these molecules as a nutritional intervention in the prevention of CVD. Although several studies have shown the individual cardioprotective nature of these compounds, a combination treatment with CPs and ω-3 fatty acids may be a promising approach to enhance the preventive value of these molecules and reduce cardiovascular risk factors associated with aging. Therefore, this article also reviews some of the key studies on the interaction between CPs and the metabolism of ω-3 fatty acids.

Keywords: cardiovascular disease; functional food; inflammation; nutrition; oxidative stress; prevention; supplementation.

Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
PUFA and eicosanoid biosynthesis. ALA (18:3n-3) and LA (18:2n-6) are PUFAs obtained from the diet. Mammals convert LA and ALA to LC fatty acids using a series of desaturation and elongation reactions. Relevant intermediates to synthesize EPA (20:5n-3), DHA (22:6n-3), and AA (20:4n-6) include stearidonic acid, eicosatetraenoic acid, γ-linolenic acid, and DGLA (20:3n-6). AA and EPA are substrates for the synthesis of eicosanoid products such as PG and LT. EPA and DHA are also metabolized to resolvins and protectins, which are very potent anti-inflammatory mediators. The products of ω-6 fatty acids tend to promote inflammation, while the products of LC ω-3 fatty acids have anti-inflammatory properties. The LC ω-3 fatty acids may reduce the risk of CVD by disrupting the biosynthesis of AA-derived inflammatory eicosanoids. AA, arachidonic acid; ALA, α-linolenic acid; CVD, cardiovascular disease; DGLA, dihomo-γ-linolenic acid; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; LA, linoleic acid; LC, long chain; LT, leukotrienes; PUFAs, polyunsaturated fatty acids; ω-3, omega-3.
FIG. 2.
FIG. 2.
Proposed nutritional strategy to reduce cardiovascular risk factors. This model links the combined use of CPs and ω-3 fatty acids to cardiovascular health promotion. The figure represents a summary of the mechanisms that could potentially contribute to prevent or reduce the onset of age-related cardiovascular events and enhance cardioprotective responses. CPs, cocoa polyphenols.

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