The Cooper Institute

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH


Berries: Superfoods for Preventing Heart Disease in Women

Posted in
Eat better

Friday, Feb 03, 2017

It’s no secret that plant-based foods are good for our health. Fruits, veggies, whole grains, and legumes are packed with nutrients, fiber, and phytochemicals (non-nutrients in plant foods that help to prevent disease). It is also well-known that coronary heart disease (CHD) is a leading cause of death and disability worldwide. CHD is a condition where the coronary arteries are occluded by plaque, which leads to myocardial infarction (heart attack).  Plaque formation in arteries begins with damage to the delicate innermost lining of the artery known as the endothelium. Think of your arteries as hoses; with blood going through the hoses instead of water. Just as water contacts the innermost lining of a hose, blood contacts the endothelial lining as it flows through the arteries. Scientists are very interested in strategies that can help to protect the endothelium and keep it functioning normally.

One type of dietary phytochemical that has a beneficial effect on the endothelial lining as well as on blood pressure are flavonoids; which are found in fruits, vegetables, tea, and wine. One particular type of flavonoid that seems to be very beneficial to arterial health are anthocyanins, which are found in relatively high amounts in red and blue colored fruits, particularly blueberries and strawberries. However, there have been very few studies examining the effects of dietary anthocyanins on coronary heart disease risk among young to middle-aged women. This issue was addressed in an important study by Cassidy, et al. (2013).  In 1989, 93600 apparently healthy women with an average age of 36 years were enrolled in phase 2 of the Nurses’ Health Study. All women completed detailed lifestyle and medical history questionnaires at baseline; follow-up questionnaires were completed every 2 years. Beginning in 1991, detailed dietary questionnaires were also completed by the women every 4 years. The women were followed through 2008, with the primary variable of interest being fatal and non-fatal myocardial infarction (MI). As part of the statistical analyses, other important factors such as smoking, body mass index, aspirin use, alcohol intake, physical activity, and family history of MI were carefully controlled for. During the 18 years of follow-up, there were 405 confirmed cases of fatal and non-fatal MI; the average age at first MI was 48 years.

Women were placed in one of five groups based on their dietary anthocyanin intake. The association between dietary anthocyanins and risk of MI is shown below in Figure 1. Anthocyanin intake was a strong predictor of MI risk; with a nearly 40% decreased risk among women with the highest anthocyanin intake compared to women with the lowest anthocyanin intake. Intake of blueberries and strawberries was a strong predictor of MI risk; with a nearly 35% decreased risk among women who consumed more than 3 servings per week compared to women who reported 0 servings per week (Figure 2).

Several mechanisms by which anthocyanins help to improve endothelial function, reduce inflammation, and decrease resting blood pressure have been identified; these are discussed in detail in the citation below.

In conclusion, this study found that anthocyanins present in blue and red colored fruits and vegetables are significantly associated with a reduced risk of MI in young to middle-aged women. Ladies, eat your berries!



Cassidy, A., Mukamal, K. J., Liu, L., Franz, M., Eliassen, A. H., Rimm, E. R. (2013).  A high anthocyanin intake is associated with a reduced risk of myocardial infarction in young and middle-aged women.  Circulation, 127(2):188-196. doi:10. 1161/CIRCULATIONAHA.112.122408