***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Evidence suggests that flavonoid-containing diets reduce cardiovascular risk , but the mechanisms responsible are unclear . In the present study , we sought to determine the effect of flavanol-rich cocoa on vascular function in individuals with CAD ( coronary artery disease ) . Forty subjects ( 61+/-8 years ; 30 male ) with CAD were recruited to a 6-week r and omized double-blind placebo-controlled study . Subjects consumed either a flavanol-rich chocolate bar and cocoa beverage daily ( total flavanols , 444 mg/day ) or matching isocaloric placebos daily ( total flavanols , 19.6 mg/day ) for 6 weeks . Brachial artery FMD ( flow-mediated dilation ) and SAC ( systemic arterial compliance ) were assessed at baseline , 90 min following the first beverage and after 3 and 6 weeks of daily consumption . Soluble cellular adhesion molecules and FBF ( forearm blood flow ) responses to ACh ( acetylcholine chloride ; 3 - 30 microg/min ) and SNP ( sodium nitroprusside ; 0.3 - 3 microg/min ) infusions , forearm ischaemia and isotonic forearm exercise were assessed at baseline and after 6 weeks . FMD , SAC and FBF responses did not differ between groups at baseline . No acute or chronic changes in FMD or SAC were seen in either group . No difference in soluble cellular adhesion molecules , FBF responses to ischaemia , exercise , SNP or ACh was seen in the group receiving flavanol-rich cocoa between baseline and 6 weeks . These data suggest that over a 6-week period , flavanol-rich cocoa does not modify vascular function in patients with established CAD BACKGROUND Inflammation is commonly associated with malnutrition and cardiovascular disease in end-stage renal failure patients . Anti-inflammatory properties of the isoflavones , a micronutrient component of soy , have been reported in several experimental models and disease conditions , but never in renal failure . We hypothesized that dietary soy isoflavones correct laboratory evidence of systemic inflammation in haemodialysis ( HD ) patients with underlying high blood levels of C-reactive protein ( CRP ) . METHODS End-stage renal disease patients on chronic HD , with elevated CRP ( > 10.0 mg/l ) were enrolled in this pilot study . The subjects were double-blind r and omly distributed with 2 : 1 ratio to receive isoflavone-containing soy-based nutritional supplements ( soy group ) or isoflavone-free milk protein ( control group ) for 8 weeks . Serum isoflavone , inflammatory markers and nutrition markers were assessed at baseline and at the end of the treatment . RESULTS Thirty-two subjects were enrolled . Fifteen subjects in the soy group and 10 in the control group completed the study ; five dropouts were due to acute illness and two due to food intolerance . After intervention , blood isoflavone levels were 5- to 10-fold higher in the soy group than in the control group [ e.g. median genistein ( 25 - 75th percentile ) : 337.9 ( 175.5 - 1007 ) nM in the soy group vs 41.4 ( 22.9 - 100.4 ) nM in the control group ; P < 0.001 ] . However , the isoflavone levels ranged widely in the soy group ( e.g. genistein : 33 - 1868 nM ) and , depending on the individual compound , four to seven subjects had end-of-treatment levels that were not different from baseline . Variation from baseline of the individual serum isoflavone levels ( Delta-isoflavone ) and CRP displayed a strong inverse correlation in the soy group ( R = -0.599 , P < 0.02 ) . In addition , Delta-isoflavone correlated positively with the variation of albumin ( R = 0.522 , P = 0.05 ) and insulin-like growth factor-1 ( R = 0.518 , P < 0.05 ) . Group levels of CRP were not statistically different after intervention although a trend towards lower levels was noted in the soy group [ 18.2 ( 12.7 - 29.1 ) mg/l at baseline vs 9.7 ( 5.2 - 20.7 ) mg/l at week 8 ; NS ] but not in the control group [ 20.6 ( 9.2 - 38.5 ) vs 17.6 ( 9.1 - 40.7 ) mg/l ] . CONCLUSION These data suggest the possibility of beneficial effects of isoflavone-rich soy foods on the inflammatory and nutritional status of HD patients with underlying systemic inflammation AIMS Flavanol-rich chocolate ( FRC ) is beneficial for vascular and platelet function by increasing nitric oxide bioavailability and decreasing oxidative stress . Congestive heart failure ( CHF ) is characterized by impaired endothelial and increased platelet reactivity . As statins are ineffective in CHF , alternative therapies are a clinical need . We therefore investigated whether FRC might improve cardiovascular function in patients with CHF . METHODS AND RESULTS Twenty patients with CHF were enrolled in a double-blind , r and omized placebo-controlled trial , comparing the effect of commercially available FRC with cocoa-liquor-free control chocolate ( CC ) on endothelial and platelet function in the short term ( 2 h after ingestion of a chocolate bar ) and long term ( 4 weeks , two chocolate bars/day ) . Endothelial function was assessed non-invasively by flow-mediated vasodilatation of the brachial artery . Flow-mediated vasodilatation significantly improved from 4.98 ± 1.95 to 5.98 ± 2.32 % ( P = 0.045 and 0.02 for between-group changes ) 2h after intake of FRC to 6.86 ± 1.76 % after 4 weeks of daily intake ( P = 0.03 and 0.004 for between groups ) . No effect on endothelial-independent vasodilatation was observed . Platelet adhesion significantly decreased from 3.9 ± 1.3 to 3.0 ± 1.3 % ( P = 0.03 and 0.05 for between groups ) 2 h after FRC , an effect that was not sustained at 2 and 4 weeks . Cocoa-liquor-free CC had no effect , either on endothelial function or on platelet function . Blood pressure and heart rate did not change in either group . CONCLUSION Flavanol-rich chocolate acutely improves vascular function in patients with CHF . A sustained effect was seen after daily consumption over a 4-week period , even after 12 h abstinence . These beneficial effects were paralleled by an inhibition of platelet function in the presence of FRC only The consumption of cocoa and dark chocolate is associated with a lower risk of CVD , and improvements in endothelial function may mediate this relationship . Less is known about the effects of cocoa/chocolate on the augmentation index ( AI ) , a measure of vascular stiffness and vascular tone in the peripheral arterioles . We enrolled thirty middle-aged , overweight adults in a r and omised , placebo-controlled , 4-week , cross-over study . During the active treatment ( cocoa ) period , the participants consumed 37 g/d of dark chocolate and a sugar-free cocoa beverage ( total cocoa = 22 g/d , total flavanols ( TF ) = 814 mg/d ) . Colour-matched controls included a low-flavanol chocolate bar and a cocoa-free beverage with no added sugar ( TF = 3 mg/d ) . Treatments were matched for total fat , saturated fat , carbohydrates and protein . The cocoa treatment significantly increased the basal diameter and peak diameter of the brachial artery by 6 % ( + 2 mm ) and basal blood flow volume by 22 % . Substantial decreases in the AI , a measure of arterial stiffness , were observed in only women . Flow-mediated dilation and the reactive hyperaemia index remained unchanged . The consumption of cocoa had no effect on fasting blood measures , while the control treatment increased fasting insulin concentration and insulin resistance ( P= 0·01 ) . Fasting blood pressure ( BP ) remained unchanged , although the acute consumption of cocoa  increased resting BP by 4 mmHg . In summary , the high-flavanol cocoa and dark chocolate treatment was associated with enhanced vasodilation in both conduit and resistance arteries and was accompanied by significant reductions in arterial stiffness in women OBJECTIVES The aim of this study was to examine the association between brachial artery flow-mediated dilation ( FMD ) and cardiovascular events in a cohort of initially asymptomatic post-menopausal women , with adjustment for the presence of the major cardiovascular risk factors . BACKGROUND Conventional major cardiovascular risk factors ( cigarette smoking , hypercholesterolemia , hypertension , and diabetes ) fail to explain nearly 50 % of cardiovascular events . Defining the magnitude of future risk for the development of clinical events is a major focus of effective primary prevention . Evaluation of endothelial function , utilizing the noninvasive measurement of the brachial artery FMD , may serve as a screening tool to individualize high-risk patients . METHODS We conducted a prospect i ve study on 2,264 post-menopausal women , age 54 + /- 6 years . The length of the follow-up was 45 + /- 13 months ( range 6 to 65 months ) . RESULTS During observation , 90 major events were recorded . Risk-adjusted relative risk values result ed 1.0 , 1.33 ( 95 % confidence interval [ CI ] 1.09 to 4.09 ) , and 4.42 ( 95 % CI 2.97 to 8.01 ) for women in the higher , intermediate , and lower tertile of FMD , respectively ( p < 0.0001 for trend ) . The event rate for women in the lower tertile ( FMD < or=4.5 % ) was greater than the combined event rate noted in the other 2 tertiles ( women in the lower tertile accounted for 51 events [ 56.6 % of total events ] ) . When added to age and other conventional cardiovascular risk factors ( smoking habits , presence of hypercholesterolemia , history of diabetes , hypertension ) , FMD contributed significantly to the model predicting cardiovascular events ( likelihood ratio chi-square change : 10.22 ; p < 0.0001 ) . CONCLUSIONS In post-menopausal women , the knowledge of FMD provided incremental prognostic information regarding the risk of developing cardiovascular events BACKGROUND Nitric oxide ( NO ) may protect arteries against atherosclerosis , as suggested by experimental studies . Estrogen therapy enhances the bioactivity of NO in the vasculature of healthy postmenopausal women , but is not acceptable for long-term use by many women . Observational studies have demonstrated beneficial cardiovascular effects of soy protein in premenopausal and postmenopausal women . We examined whether the consumption of isolated soy protein may improve markers of vascular inflammation in postmenopausal women with hypercholesterolemia . METHODS AND RESULTS In a r and omized , double-blind , placebo-controlled , crossover study , 24 postmenopausal women with hypercholesterolemia received 25 g of soy protein or a placebo daily for 6 weeks , with treatment periods separated by 1 month . Markers of vascular inflammation were measured by enzyme-linked immunosorbent assay methods , including : soluble interleukin-2 receptor ( sIL-2r ) , E-selectin , P-selectin , intercellular adhesion molecule-1 ( ICAM-1 ) , and vascular cell adhesion molecule-1 ( VCAM-1 ) . There was no effect of soy protein in comparison with placebo on the inflammatory markers : the sIL-2r level was 942.2 + /- 335.3 pg/mL with soy protein and 868.5 + /- 226.9 pg/mL with placebo ( P = .311 ) ; E-selectin was 39.6 + /- 16.5 ng/mL with soy protein and 42.1 + /- 17.6 ng/mL with placebo ( P = .323 ) ; P-selectin was 157.9 + /- 67.9 ng/mL with soy protein and 157.5 + /- 47.6 ng/mL with placebo , ( P = .977 ) ; ICAM-1 was 266.0 + /- 81.3 ng/mL with soy protein and 252.5 + /- 82.7 ng/mL with placebo ( P = .435 ) ; VCAM-1 was 402.7 + /- 102.1 ng/mL with soy protein and 416.4 + /- 114.8 ng/mL with placebo ( P = .53 ) . CONCLUSIONS Consumption of 25 g of isolated soy protein daily for 6 weeks does not substantially affect markers of vascular inflammation in postmenopaus 
    Output:
    
Evidence shows that certain polyphenols , such as flavonols can be helpful in decreasing CVD risk factors .
However , further rigorous evidence is necessary to support the BAC effect on CVD prevention and treatment