Chocolate Consumption and Myocardial Infarction Risk

Study Questions:

Is chocolate consumption associated with risk for ischemic heart disease?


Data from two prospective population-based cohorts of Swedish adults, which collected data on diet, were used for the prospective study. The Cohort of Swedish Men and the Swedish Mammography Cohort were used for the present analysis. Participants had completed a food-frequency questionnaire and were free of cardiovascular disease at baseline. The primary outcome of interest was myocardial infarction (MI), which was identified through linkage with the Swedish National Patient and Cause of Death Registries. For the meta-analysis, PubMed and EMBASE databases were searched using the terms chocolate or cocoa combined with cardiovascular disease or myocardial infarction or heart disease. Prospective studies published prior to February 2016, which provided data on chocolate consumption and risk of ischemic heart disease, were identified.


A total 67,640 men and women were included in the analysis from the Swedish cohorts. During follow-up, which was from 1998 to 2010, 4,417 cases of MI were identified in the Swedish study. Compared with nonconsumers of chocolate, men and women who consumed ≥3-4 servings/week of chocolate were more likely to have a university education, but less likely to be current smokers, overweight, and to have a history of diabetes, hypertension, and hypercholesterolemia. Chocolate consumption was inversely associated with MI risk. Compared with nonconsumers, the relative risk for those who consumed ≥3-4 servings/week of chocolate was 0.87 (95% confidence interval [CI], 0.77-0.98; p for trend = 0.04). For the meta-analysis, five prospective studies were identified which reported chocolate consumption and ischemic heart disease. Together with the Swedish data, the meta-analysis included six studies, with a total of 6,851 cases of ischemic heart disease. The overall relative risk for the highest versus lowest category of chocolate consumption was 0.90 (95% CI, 0.82-0.97), with little heterogeneity among studies (I2 = 24.3%).


The investigators concluded that chocolate consumption was associated with a lower risk of MI and ischemic heart disease.


Although these data along with prior studies support the benefit of chocolate, moderate consumption should be recommended.

Clinical Topics: Dyslipidemia, Prevention, Atherosclerotic Disease (CAD/PAD), Homozygous Familial Hypercholesterolemia, Diet, Hypertension, Smoking

Keywords: Cacao, Coronary Artery Disease, Diabetes Mellitus, Diet, Hypercholesterolemia, Hypertension, Myocardial Infarction, Myocardial Ischemia, Overweight, Primary Prevention, Risk, Smoking

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