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This article originally posted 15 December, 2011 and appeared in  DietCardiovascularIssue 604

The Final Word on Chocolate Intake and Benefits to the Heart and Brain

A study by Buitrago-Lopez and colleagues found that daily chocolate consumption had a positive effect on cardiovascular risk factors....

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This meta-analysis by Buitrago-Lopez and colleagues assesses the association between chocolate intake and the risk for cardiometabolic disorders overall, in addition to the risk for cardiovascular disease, diabetes, stroke, and heart failure. And, British investigators reported the results of a new study in Paris showing that chocolate is good for the heart and brain. They reported that individuals who ate the most chocolate had a 37% lower risk of cardiovascular disease and a 29% lower risk of stroke compared with individuals who ate the least amount of chocolate.

In the study, Dr. Adriana Buitrago-Lopez (University of Cambridge, UK) and colleagues stated that, "Although overconsumption can have harmful effects, the existing studies generally agree on a potential beneficial association of chocolate consumption with a lower risk of cardiometabolic disorders. Our findings confirm this, and we found that higher levels of chocolate consumption might be associated with a one-third reduction in the risk of developing cardiovascular disease."

In this meta-analysis of six cohort studies and one cross-sectional study, overall chocolate consumption was reported, with investigators not differentiating between dark, milk, or white chocolate. Chocolate in any form was included, such as chocolate bars, chocolate drinks, and chocolate snacks, such as confectionary, biscuits, desserts, and nutritional supplements. Chocolate consumption was reported differently in the trials but ranged from never to more than once per day. Most patients included in the trials were white, although one study included Hispanic and African Americans and one study included Asian patients.

Of the seven studies, five trials reported a significant inverse association between chocolate intake and cardiometabolic disorders. For example, individual studies showed reductions in the risk of coronary heart disease (odds ratio 0.43; 95% CI 0.27–0.68), the risk of cardiovascular disease mortality (relative risk [RR] 0.50; 95% CI 0.32–0.78), and the risk of incident diabetes in men (hazard ratio 0.65; 95% CI 0.43–0.97). Overall, the pooled meta-analysis results showed that high levels of chocolate consumption compared with the lowest levels of chocolate consumption reduced the risk of any cardiovascular disease 37% (RR 0.63; 0.44-0.90) and stroke 29% (RR 0.71; 0.52-0.98). There was no association between chocolate consumption and the risk of heart failure, and no association on the incidence of diabetes in women.

The researchers note that the findings corroborate the results of previous meta-analyses of experimental and observational studies in different populations showing a similar relationship between chocolate and cocoa consumption and cardiometabolic disorders.

"These favorable effects seem mainly mediated by the high content of polyphenols present in cocoa products and are probably accrued through the increasing bioavailability of nitric oxide, which subsequently might lead to improvements in endothelial function, reductions in platelet function, and additional beneficial effects on blood pressure, insulin resistance, and blood lipids," conclude Buitrago-Lopez and colleagues.

Practice Pearls:
  • Higher chocolate intake is related to a decreased risk for cardiometabolic disorders overall in 5 of 7 studies.
  • Higher chocolate intake is related to a reduced risk for cardiovascular disease by 37%, diabetes by 31%, and stroke by 29%. There is no link between chocolate intake and heart failure.

Buitrago-Lopez A, Sanderson J, Johnson L, et al. Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. BMJ 2011; DOI:10.1136/bmj.d4488

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This article originally posted 15 December, 2011 and appeared in  DietCardiovascularIssue 604

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