Anthocyanins have become increasingly important to the food industry as their use as natural alternatives to artificial colors has become widespread and knowledge of their health-promoting properties has become more evident. Epidemiological studies suggest that increased consumption of anthocyanins lowers the risk of cardiovascular disease CVD , the most common cause of mortality among men and women.

Anthocyanins frequently interact with other phytochemicals, exhibiting synergistic biological effects but making contributions from individual components difficult to decipher.

Over the past 2 decades, many peer-reviewed publications have demonstrated that in addition to their noted in vitro antioxidant activity, anthocyanins may regulate different signaling pathways involved in the development of CVD.

Limited yet promising data from epidemiological studies and human clinical trials are also presented. Cassidy A, Mukamal KJ, Liu L, Franz M, Eliassen AH, Rimm EB. High anthocyanin intake is associated with a reduced risk of myocardial infarction in young and middle-aged women.

Article CAS PubMed PubMed Central Google Scholar. Cassidy A, Bertoia M, Chiuve S, Flint A, Forman J, Rimm EB. Habitual intake of anthocyanins and flavanones and risk of cardiovascular disease in men. Am J Clin Nutr. Fairlie-Jones L, Davison K, Fromentin E, Hill A. The effect of anthocyanin-rich foods or extracts on vascular function in adults: a systematic review and meta-analysis of randomised controlled trials.

Article PubMed Central CAS Google Scholar. Traustadóttir T, Davies SS, Stock AA, Su Y, Heward CB, Roberts LJ, et al. Tart cherry juice decreases oxidative stress in healthy older men and women. Davinelli S, Bertoglio JC, Zarrelli A, Pina R, Scapagnini G. A randomized clinical trial evaluating the efficacy of an anthocyanin-Maqui berry extract Delphinol® on oxidative stress biomarkers.

J Am Coll Nutr. Li D, Zhang Y, Liu Y, Sun R, Xia M. Purified anthocyanin supplementation reduces dyslipidemia, enhances antioxidant capacity, and prevents insulin resistance in diabetic patients. Basu A, Betts NM, Ortiz J, Simmons B, Wu M, Lyons TJ. Low-calorie cranberry juice decreases lipid oxidation and increases plasma antioxidant capacity in women with metabolic syndrome.

Nutr Res N Y N. Kuntz S, Kunz C, Herrmann J, Borsch CH, Abel G, Fröhling B, et al. Anthocyanins from fruit juices improve the antioxidant status of healthy young female volunteers without affecting anti-inflammatory parameters: results from the randomised, double-blind, placebo-controlled, cross-over ANTHONIA ANTHOcyanins in nutrition investigation Alliance study.

Kardum N, Konić-Ristić A, Savikin K, Spasić S, Stefanović A, Ivanišević J, et al. J Med Food. Systematic review of anthocyanins and markers of cardiovascular disease. Fasting compared with nonfasting lipids and apolipoproteins for predicting incident cardiovascular events.

Important information distinguishing the implications of fasting and postprandial lipid in predicting cardiovascular events. Bansal S, Buring JE, Rifai N, Mora S, Sacks FM, Ridker PM. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. Zhu Y, Ling W, Guo H, Song F, Ye Q, Zou T, et al.

Anti-inflammatory effect of purified dietary anthocyanin in adults with hypercholesterolemia: a randomized controlled trial. Nutr Metab Cardiovasc Dis. Edirisinghe I, Banaszewski K, Cappozzo J, Sandhya K, Ellis CL, Tadapaneni R, et al.

Strawberry anthocyanin and its association with postprandial inflammation and insulin. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al.

The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials.

BMJ [Internet]. Alqurashi RM, Galante LA, Rowland IR, Spencer JP, Commane DM. Consumption of a flavonoid-rich açai meal is associated with acute improvements in vascular function and a reduction in total oxidative status in healthy overweight men. Miglio C, Peluso I, Raguzzini A, Villaño DV, Cesqui E, Catasta G, et al.

Fruit juice drinks prevent endogenous antioxidant response to high-fat meal ingestion. Peluso I, Raguzzini A, Villano VD, Cesqui E, Toti E, Catasta G, et al. High fat meal increase of IL is prevented by ingestion of fruit juice drink in healthy overweight subjects. Curr Pharm Des. Polley KR, Oswell NJ, Pegg RB, Cooper JA.

Tart cherry consumption with or without prior exercise increases antioxidant capacity and decreases triglyceride levels following a high-fat meal. Appl Physiol Nutr Metab Physiol Appl Nutr Metab.

Huebbe P, Giller K, de Pascual-Teresa S, Arkenau A, Adolphi B, Portius S, et al. Effects of blackcurrant-based juice on atherosclerosis-related biomarkers in cultured macrophages and in human subjects after consumption of a high-energy meal.

Ono-Moore KD, Snodgrass RG, Huang S, Singh S, Freytag TL, Burnett DJ, et al. Postprandial inflammatory responses and free fatty acids in plasma of adults who consumed a moderately high-fat breakfast with and without blueberry powder in a randomized placebo-controlled trial.

Park E, Edirisinghe I, Wei H, Vijayakumar LP, Banaszewski K, Cappozzo JC, et al. A dose-response evaluation of freeze-dried strawberries independent of fiber content on metabolic indices in abdominally obese individuals with insulin resistance in a randomized, single-blinded, diet-controlled crossover trial.

Mol Nutr Food Res. Huang Y, Park E, Edirisinghe I, Burton-Freeman BM. Maximizing the health effects of strawberry anthocyanins: understanding the influence of the consumption timing variable.

Food Funct. Kay CD, Holub BJ. The effect of wild blueberry Vaccinium angustifolium consumption on postprandial serum antioxidant status in human subjects. Richter CK, Skulas-Ray AC, Gaugler TL, Lambert JD, Proctor DN, Kris-Etherton PM.

Incorporating freeze-dried strawberry powder into a high-fat meal does not alter postprandial vascular function or blood markers of cardiovascular disease risk: a randomized controlled trial.

Orange juice intake during a fatty meal consumption reduces the postprandial low-grade inflammatory response in healthy subjects. Thromb Res. Urquiaga I, Ávila F, Echeverria G, Perez D, Trejo S, Leighton F. A Chilean berry concentrate protects against postprandial oxidative stress and increases plasma antioxidant activity in healthy humans.

Prior RL. J Funct Foods. Ras RT, Streppel MT, Draijer R, Zock PL. Flow-mediated dilation and cardiovascular risk prediction: a systematic review with meta-analysis.

Int J Cardiol. Inaba Y, Chen JA, Bergmann SR. Prediction of future cardiovascular outcomes by flow-mediated vasodilatation of brachial artery: a meta-analysis.

Int J Card Imaging. Article Google Scholar. Magnitude and timing of the postprandial inflammatory response to a high-fat meal in healthy adults: a systematic review. Adv Nutr Int Rev J.

Evidence of how high-fat meal challenges exert effects of in the post-prandial inflammatory response in humans. Volpato S, Guralnik JM, Ferrucci L, Balfour J, Chaves P, Fried LP, et al. Su D, Li Z, Li X, Chen Y, Zhang Y, Ding D, et al. Association between serum interleukin-6 concentration and mortality in patients with coronary artery disease.

Mediat Inflamm. Bacchiega BC, Bacchiega AB, Usnayo MJG, Bedirian R, Singh G, Pinheiro GRC. Interleukin 6 inhibition and coronary artery disease in a high-risk population: a prospective community-based clinical study.

J Am Heart Assoc [Internet]. Morais CA, de Rosso VV, Estadella D, Pisani LP. Anthocyanins as inflammatory modulators and the role of the gut microbiota. J Nutr Biochem.

Kaori M, Makiko T, Shuhei O, Shigetaka F, Manabu S, Hideki M, et al. Association between onterleukin-6 levels and first-ever cerebrovascular events in patients with vascular risk factors.

Arterioscler Thromb Vasc Biol American Heart Association. Wainstein MV, Mossmann M, Araujo GN, Gonçalves SC, Gravina GL, Sangalli M, et al. Elevated serum interleukin-6 is predictive of coronary artery disease in intermediate risk overweight patients referred for coronary angiography. Diabetol Metab Syndr [Internet].

Danesh J, Kaptoge S, Mann AG, Sarwar N, Wood A, Angleman SB, et al. Long-term interleukin-6 levels and subsequent risk of coronary heart disease: two new prospective studies and a systematic review. PLoS Med [Internet].

Zhang B, Li X-L, Zhao C-R, Pan C-L, Zhang Z. Interleukin-6 as a predictor of the risk of cardiovascular disease: a meta-analysis of prospective epidemiological studies. Williams ES, Shah SJ, Ali S, Na BY, Schiller NB, Whooley MA. C-reactive protein, diastolic dysfunction, and risk of heart failure in patients with coronary disease: heart and soul study.

Eur J Heart Fail. Ridker PM, Kastelein JJP, Genest J, Koenig W. C-reactive protein and cholesterol are equally strong predictors of cardiovascular risk and both are important for quality clinical care.

Eur Heart J. Cozlea DL, Farcas DM, Nagy A, Keresztesi AA, Tifrea R, Cozlea L, et al. The impact of C reactive protein on global cardiovascular risk on patients with coronary artery disease.

Curr Health Sci J. Hein TW, Singh U, Vasquez-Vivar J, Devaraj S, Kuo L, Jialal I. Human C-reactive protein induces endothelial dysfunction and uncoupling of eNOS in vivo.

Devaraj S, Kumaresan PR, Jialal I. C-reactive protein induces release of both endothelial microparticles and circulating endothelial cells in vitro and in vivo: further evidence of endothelial dysfunction. Clin Chem. Urschel K, Cicha I. Int J Interferon Cytokine Mediat Res.

Zhang H, Park Y, Wu J, Ping CX, Lee S, Yang J, et al. Role of TNF-α in vascular dysfunction. Clin Sci Lond Engl Robert M, Miossec P. Effects of interleukin 17 on the cardiovascular system.

Autoimmun Rev. Ding H-S, Yang J, Yang J, Ding J-W, Chen P, Zhu P. Interleukin contributes to cardiovascular diseases. Mol Biol Rep. Li Q, Wang Y, Chen K, Zhou Q, Wei W, Wang Y, et al. Biochem Biophys Res Commun.

Giera M, Lingeman H, Niessen WMA. Recent advancements in the LC- and GC-based analysis of malondialdehyde MDA : a brief overview. Fedorova M, Bollineni RC, Hoffmann R. Protein carbonylation as a major hallmark of oxidative damage: update of analytical strategies.

Mass Spectrom Rev. Boligon AA. Technical evaluation of antioxidant activity. Med Chem [Internet]. Gaggini M, Sabatino L, Vassalle C. Conventional and innovative methods to assess oxidative stress biomarkers in the clinical cardiovascular setting. BioTech Future Sci. CAS Google Scholar.

Ok EJ, Kim K, Park SB.