Habitual Chocolate Intake and Cardiovascular Risk | Journal Scan

Study Questions:

What is the association between chocolate intake and the risk of future cardiovascular events?


A prospective study was conducted using data from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Habitual chocolate intake was quantified using the baseline food frequency questionnaire (1993–1997), and cardiovascular endpoints were ascertained up to March 2008. A systematic review was then performed to evaluate chocolate consumption and cardiovascular outcomes.


A total of 20,951 men and women were included in EPIC-Norfolk analysis (mean follow-up 11.3 ± 2.8 years, median 11.9 years). Higher consumption of chocolate was more often found in men, current smokers, higher use of alcohol, greater caloric intake, lower body mass index, more often active, and less diabetes. The percentage of participants with coronary heart disease (CHD) in the highest and lowest quintile of chocolate consumption was 9.7% and 13.8%, and the respective rates for stroke were 3.1% and 5.4%. The multivariate-adjusted hazard ratio (HR) for CHD was 0.88 (95% confidence interval [CI], 0.77-1.01) for those in the top quintile of chocolate consumption (16-99 g/day) versus nonconsumers of chocolate intake. The corresponding HR for stroke and cardiovascular disease (sum of CHD and stroke) was 0.77 (95% CI, 0.62-0.97) and 0.86 (95% CI, 0.76-0.97). The propensity score matched estimates showed a similar trend. A total of nine studies with 157,809 participants were included in the meta-analysis. Higher compared to lower chocolate consumption was associated with significantly lower CHD risk (five studies; pooled relative risk [RR], 0.71; 95% CI, 0.56-0.92), stroke (five studies; pooled RR, 0.79; 95% CI, 0.70-0.87), composite cardiovascular adverse outcome (two studies; pooled RR, 0.75; 95% CI, 0.54-1.05), and cardiovascular mortality (three studies; pooled RR, 0.55; 95% CI, 0.36-0.83).


Cumulative evidence suggests that higher chocolate intake is associated with a lower risk of future cardiovascular events, although residual confounding cannot be excluded. There does not appear to be any evidence to say that chocolate should be avoided in those who are concerned about cardiovascular risk.


Similar prospective cohort studies have shown the cardiovascular protective effects of regular consumption of cocoa. Among the putative values of chocolate include the bioflavonoids as potent antioxidants that reduce low-density lipoprotein oxidation, increase high-density lipoprotein cholesterol, and improve endothelial function, The high range of 16-99 g/day of chocolate equates to from one half to 4 ounces of chocolate. A 1 ounce serving of dark or milk chocolate has about 150 calories. Dark chocolate has less sugar and fat than milk chocolate.

Clinical Topics: Prevention, Diet

Keywords: Antioxidants, Cacao, Carbohydrates, Cardiovascular Diseases, Coronary Disease, Energy Intake, Flavonoids, Follow-Up Studies, Mortality, Neoplasms, Patient Outcome Assessment, Primary Prevention, Propensity Score, Prospective Studies, Risk, Risk Factors, Stroke

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