Chocolate Intake and Risk of Atrial Fibrillation

Study Questions:

Is chocolate intake associated with reduced incident atrial fibrillation or flutter (AF)?


Data from the Danish Diet, Cancer, and Health Study, a large population-based prospective cohort study, were used for the current analysis. Participants were enrolled between December 1993 and May 1997. Adults had to be between 50 and 64 years of age, reside in the greater Copenhagen or Aarhus area, and have no diagnosis of cancer upon enrollment. Diet was assessed through a self-administered food frequency questionnaire. The primary outcome of incident cases of AF was ascertained by linkage with nationwide registries.


A total of 55,502 participants (26,400 men and 29,102 women) who had provided information on chocolate intake at baseline were included. Over a median follow-up of 13.5 years, a total of 3,346 cases of AF were identified. Compared with chocolate intake less than once per month, the rate of AF was lower for people consuming 1–3 servings/month (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.82-0.98), 1 serving/week (HR, 0.83; 95% CI, 0.74-0.92), 2–6 servings/week (HR, 0.80; 95% CI, 0.71-0.91), and ≥1 servings/day (HR, 0.84; 95% CI, 0.65-1.09; p-linear trend < 0.0001). Models were adjusted for total calories, sex, body mass index, systolic blood pressure, total serum cholesterol, coffee consumption, alcohol consumption, smoking status, education, hypertension, diabetes mellitus, and cardiovascular disease. Results were similar for men and women.


The authors concluded that moderate chocolate intake may be inversely associated with AF risk, although residual confounding cannot be ruled out.


The anti-inflammatory effects of cocoa have been associated with lower risk for cardiovascular events; however, the present study presents evidence for the benefits of chocolate in relation to AF. It is not clear as to the cocoa content of the chocolate consumed, making a dose response difficult to determine. Additional mechanistic studies as well as additional studies in other populations are warranted prior to the prescription of chocolate to reduce risk for AF.

Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Diet

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Cacao, Diet, Primary Prevention, Risk Factors

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