Anthocyanins linked to 26% lower CVD incidence

Anthocyanins are the pigments that make berries, black grapes and purple vegetables their colour, and earlier pooled analyses have suggested they benefit cardiometabolic health. The catch is that much of that work mixed healthy volunteers with people who already had raised blood pressure, diabetes or heart disease, where any compound has more room to show an effect. That leaves an obvious question for the general reader who is not a patient: does an ordinary dietary intake do anything measurable in healthy people? This review was built specifically to answer that narrower question.

The team searched PubMed, Cochrane Central, the Commonwealth Agricultural Bureau database and Web of Science for publications from 1946 to September 2024 that reported anthocyanin intake alongside cardiovascular disease risk or cardiometabolic biomarkers. They restricted the analysis to healthy participants, and to randomised trials providing at least 50 mg per day of anthocyanins. Eighteen prospective cohorts across 27 publications supplied the clinical endpoints, and 65 randomised controlled trials supplied biomarker outcomes including flow-mediated dilation, insulin, glucose, lipids, blood pressure and pulse wave velocity. Results were pooled with random-effects meta-analysis and the certainty of evidence was graded using GRADE.

In the cohorts, the highest versus lowest habitual anthocyanin intake was associated with 26% lower cardiovascular disease incidence, 18% lower myocardial infarction, 11% lower type 2 diabetes, 9% lower cardiovascular mortality and 8% lower hypertension risk; stroke risk was unaffected, and GRADE rated the evidence moderate for cardiovascular disease and myocardial infarction. In the trials, chronic intake improved flow-mediated dilation by a net 1.41% (95% CI 0.90% to 1.91%) and acute intake by 1.50%, with acute intake also lowering insulin by 2.24 pmol/L. Lipids, blood pressure, glucose and HOMA-IR did not change. By anthocyanin type, cyanidin improved chronic flow-mediated dilation, while delphinidin additionally improved pulse wave velocity, insulin and triglycerides.

This extends previous meta-analyses from mixed and diseased populations to healthy people, and it does so at intakes the authors describe as dietarily achievable. The two evidence streams line up in direction, which strengthens the overall picture, but they are not equivalent: the cohorts measure real disease over years and cannot exclude confounding, while the trials measure short-term markers of vessel and metabolic function. Notably, some of the outcomes people most associate with heart health — cholesterol, blood pressure and fasting glucose — did not move in the trials. Whether raising anthocyanin intake actually prevents events in healthy people remains untested by randomised trials.

This is a reason to think of anthocyanin-rich foods such as berries and other deeply coloured fruit and vegetables as a sensible part of a heart-healthy diet rather than as a treatment. The vessel-function improvement in trials appeared at intakes as low as 50 mg/d, which sits within normal eating rather than requiring supplementation. The lower disease rates come from observational data, so people eating more anthocyanins may differ in other ways. It is also worth knowing that a berry industry body part-funded the review, even though it reportedly had no role in the analysis.