By Craig Weatherby
Women have special concerns when it comes to heart health.
As we wrote in “Women's Heart Risks Form Focus of 'Wear Red'”, women's heart disease differs from men's and defies detection.
While preventive measures are smart for all, the stealthy nature of women's heart disease makes it more vital for them to minimize risk by adopting heart-healthy lifestyles.
The standard American diet – overly high in starches and omega-6 fats from cheap vegetable oils – heightens women's heart risks: see “Women's Hearts Damaged by Starchy Diets”, “Women's Excess Omega-6 Intake Raises Health Risks, and “Women's Heart Risk Cut by Fish but Frying it Outweighs the Benefit”.
Although their evidence is mixed, epidemiological (population) studies suggest that women may reduce cardiovascular risks by favoring plant foods rich in polyphenol-class “antioxidants”.
Now, Australian researchers report strong links between diets high in antioxidant-rich plant foods to sharply reduced risk of death from cardiovascular disease among older women.
They looked for links between women's estimated intake of flavonols and the risk of dying from heart disease.
Polyphenol-type antioxidants occur in most plant foods, but abound especially in onions, dark leafy greens, coffee, cocoa, cooking herbs, beans, leafy greens, apples, broccoli, berries, tea, extra virgin olive oil, citrus, whole grains, and whole nuts.
Their epidemiological study indicates that women eating diets high in flavonols were much less likely to have died from cardiovascular disease within five years.
Study links food-borne antioxidants to reduced heart deaths among women
The Australian team, based at the University of Western Australia, analyzed data from a study involving 1,063 women over the age of 75.
The scientists estimated the women's flavonol intakes using diet questionnaires and data from the US Department of Agriculture (USDA).
They estimated intakes for the seven major classes of flavonol-class polyphenols:
  • Flavanones (citrus fruits)
  • Isoflavones (e.g., soybeans, legumes).
  • Flavones (parsley, thyme, celery, hot peppers,)
  • Anthocyanidins (e.g., red-purple berries and grapes; red wine)
  • Flavan-3-ols (tea, cocoa, dark chocolate, grapes, berries, apples)
  • Flavonols* (onions, dark leafy greens, broccoli, apples, berries, tea)
  • Proanthocyanidins (berries, cocoa, , dark chocolate, apples, red grapes)
*Confusingly, this subgroup of flavonol-class polyphenols is also called “flavonols”.
After five years, the women reporting the highest flavonol intakes were 73 percent less likely to have died from cardiovascular disease, compared to the women with the lowest average intakes.
The analysis detected a similar, 62 percent death-risk reduction among women getting more flavonols that most from tea or other food sources (59 percent reduction).
Adding to the attractions of tea and cocoa – the richest sources of rare flavon-3-ols – the analysis linked higher intakes of these uncommon polyphenols with a comparably significant drop in risk.
As the researchers wrote, “Both tea and non-tea sources of flavonols were independently associated with this benefit. The cardioprotective benefits of flavonols appear to be independent of the benefits ascribable to tea consumption.” “This provides further support for the suggestion that flavonols and flavan-3-ols can contribute to cardiovascular health.” (Ivey KL et al. 2013)
Given the mixed record of prior epidemiological studies, the Aussie team added a conservative caveat:
“… further observational and intervention trials are necessary to establish the clinical benefits of flavonol consumption, independent of tea.” (Ivey KL et al. 2013)
But this caution underplays the very strong lab evidence of beneficial genetic effects – anti-inflammatory, anti-cancer – from antioxidant-rich (i.e., high-polyphenol) produce, cocoa, and tea.
Even the USDA – not known to push produce – recommends getting “Five a Day” servings of fruits and vegetables. So it seems a no-brainer, tasty idea for women – and men – to eat as much produce as possible.
For maximum impact, favor these drinks and foods, in no particular order (go easy on the grains):
  • Tea
  • Beans
  • Coffee
  • Onions
  • Berries
  • Citrus fruits
  • Extra virgin olive oil
  • Whole grains, buckwheat, and nuts
  • Cocoa (non-alkalized / non-Dutched)
  • Extra-dark chocolate (65-85% cocoa)
  • Colorful – hence antioxidant-rich – fruits and veggies
Tasty medicine to take!
  • Arts IC, Hollman PC, Feskens EJ, Bueno de Mesquita HB, Kromhout D. Catechin intake might explain the inverse relation between tea consumption and ischemic heart disease: the Zutphen Elderly Study. Am J Clin Nutr. 2001 Aug;74(2):227-32.
  • Hertog MG, Feskens EJ, Hollman PC, Katan MB, Kromhout D. Dietary antioxidant flavonoids and risk of coronary heart disease: the Zutphen Elderly Study. Lancet. 1993 Oct 23;342(8878):1007-11.
  • Hertog MG, Sweetnam PM, Fehily AM, Elwood PC, Kromhout D. Antioxidant flavonols and ischemic heart disease in a Welsh population of men: the Caerphilly Study. Am J Clin Nutr. 1997 May;65(5):1489-94.
  • Ivey KL, Lewis JR, Prince RL, Hodgson JM. Tea and non-tea flavonol intakes in relation to atherosclerotic vascular disease mortality in older women. Br J Nutr. 2013 Apr 29:1-8. [Epub ahead of print]
  • Lin J, Rexrode KM, Hu F, Albert CM, Chae CU, Rimm EB, Stampfer MJ, Manson JE. Dietary intakes of flavonols and flavones and coronary heart disease in US women. Am J Epidemiol. 2007 Jun 1;165(11):1305-13. Epub 2007 Mar 22.
  • Oregon State University / Linus Pauling Institute / Micronutrient Research for Optimum Health / Flavonoids. Accessed May 3, 2013 at
  • Sesso HD, Gaziano JM, Liu S, Buring JE. Flavonoid intake and the risk of cardiovascular disease in women. Am J Clin Nutr. 2003 Jun;77(6):1400-8. Song WO, Chun OK. Tea is the major source of flavan-3-ol and flavonol in the U.S. diet. J Nutr. 2008 Aug;138(8):1543S-1547S.
  • Song Y, Manson JE, Buring JE, Sesso HD, Liu S. Associations of dietary flavonoids with risk of type 2 diabetes, and markers of insulin resistance and systemic inflammation in women: a prospective study and cross-sectional analysis. J Am Coll Nutr. 2005 Oct;24(5):376-84.