Eating chocolate can be good for the heart

2006 HerbClipT
Mariann Garner-Wizard Heather S Oliff, PhD
Shari Henson Brenda Milot, ELS
Marissa Oppel, MS Cathleen Rapp, ND
Densie Webb, PhD

Executive Editor - Mark Blumenthal Managing Editor - Lori Glenn
Consulting Editors - Dennis Awang, PhD, Steven Foster, Roberta Lee, MD
Funding/Administration - Wayne Silverman, PhD Production - George Solis

Chocolate Consumption and the Reduced Risk of Cardiovascular Disease

Ding E, Hutfless S, Ding X, Girotra S. Chocolate and prevention of cardiovascular disease: a systematic review. Nutr & Metabol. 2006;3(2):1-12.

Cardiovascular disease (CVD) is the leading cause of death worldwide. The results of many studies suggest that changes in lifestyle factors, such as exercise and nutrition, may reduce the risk of CVD. Flavonoids-an antioxidant found in foods such as fruit, vegetables, coffee (Coffea spp.), tea (Camellia sinensis), wine (Vitis vinifera), and chocolate (Theobroma cacao)-have attracted much interest because of their potential to protect against CVD. Chocolate has been used since ancient times as a medicinal remedy and has recently been recognized for its antioxidant potential. Although many short-term trials have explored the possible health benefits of chocolate, thought to be due to its stearic acid and antioxidant flavonoid contents, no long-term trials have assessed the possible beneficial effects of chocolate consumption. Thus, the long-term beneficial effects of chocolate are debatable. This systematic review was conducted to evaluate the controversial health benefits of chocolate consumption as they relate to CVD.

The authors conducted a literature search of the MEDLINE database (National Library of Medicine, Bethesda, MD) for clinical, observational, and experimental studies of the relation between chocolate consumption and CVD that were published from January 1965 to June 2005. The search terms included chocolate, stearic acid, flavonoids, cardiovascular disease, blood pressure, cholesterol, oxidation, and thrombosis. Approximately 400 articles were found, and 136 were selected for review. Randomized trials with either a cross-sectional or parallel design and prospective observational studies were the focus. The strength of the evidence of chocolate’s beneficial effect was based on the study design and quality of individual studies, the consistency of findings across studies, and the biologic plausibility of the mechanisms involved. Relative risks were estimated and pooled according to a random-effects model.

Overall, evidence from the short-term randomized trials and from the epidemiologic studies of chocolate consumption suggests that “flavonoid intake from chocolate is likely protective against CVD, particularly CHD [coronary heart disease] mortality.” Evidence from laboratory experiments and randomized trials suggests that stearic acid has beneficial or neutral effects on clotting factors and blood pressure; thus, it is unlikely that stearic acid would adversely affect CVD risk. However, evidence from observational studies of the relation between stearic acid and CVD risk is inconclusive. A meta-analysis of seven prospective studies found that the intake of chocolate flavonoids may lower the risk of mortality from CHD. Eight cohort studies consistently found that the risk of CHD mortality was lower with total or specific flavonoid intake. However, a large cohort study (n = 38,455 women) found a nonsignificant association between CHD mortality and flavonoid intake.

On the basis of this systematic review, the authors suggest that “stearic acid may be neutral, while flavonoids are likely protective against CVD.” Because dark chocolate contains substantially higher amounts of flavonoids than does milk chocolate, the authors suggest that “it would be more prudent to consume high flavonoid dark chocolate rather than milk chocolate.” Long-term randomized feeding trials need to be conducted to definitively determine the effect of chocolate consumption on cardiovascular disease risk.

-Brenda Milot, ELS

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