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Current Atherosclerosis Reports

, Volume 13, Issue 6, pp 447–452 | Cite as

Chocolate and Coronary Heart Disease: A Systematic Review

  • Owais Khawaja
  • J. Michael Gaziano
  • Luc Djoussé
Nutrition (William S. Harris, Section Editor)

Abstract

Coronary heart disease (CHD) is the leading cause of death in the United States. The high content of polyphenols and flavonoids present in cocoa has been reported to play an important protective role in the development of CHD. Although studies have demonstrated beneficial effects of chocolate on endothelial function, blood pressure, serum lipids, insulin resistance, and platelet function, it is unclear whether chocolate consumption influences the risk of CHD. This article reviews current evidence on the effects of cocoa/chocolate on clinical and subclinical CHD, CHD risk factors, and potential biologic mechanisms. It also discusses major limitations of currently available data and future directions in the field.

Keywords

Chocolate Cocoa Flavanol Polyphenols Coronary heart disease Blood pressure Epicatechin Catechin 

Notes

Disclosure

O. Khawaja: none; J.M. Gaziano: none; L. Djoussé’s institution received an investigator-initiated grant.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Heart Attack and Angina Statistics. Available at http://www.americanheart.org/presenter.jhtml?identifier=4591. Accessed October 23 rd. 2010.
  2. 2.
    Xu J, Kochanek KD, Murphy S, Tejada-Vera B. Deaths: final data for 2007. Hyattsville, Md: National Center for Health Statistics; 2010. National Vital Statistics Reports, Vol 58, No. 19.Google Scholar
  3. 3.
    Hu FB, Willett WC. Optimal diets for prevention of coronary heart disease. JAMA. 2002;288:2569–78.PubMedCrossRefGoogle Scholar
  4. 4.
    Tanasescu M, Leitzmann MF, Rimm EB, et al. Exercise type and intensity in relation to coronary heart disease in men. JAMA. 2002;288:1994–2000.PubMedCrossRefGoogle Scholar
  5. 5.
    Weisburger JH. Eat to live, not live to eat. Nutrition. 2000;16:767–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343:16–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Kris-Etherton PM, Keen CL. Evidence that the antioxidant flavonoids in tea and cocoa are beneficial for cardiovascular health. Curr Opin Lipidol. 2002;13:41–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Visioli F, Borsani L, Galli C. Diet and prevention of coronary heart disease: the potential role of phytochemicals. Cardiovasc Res. 2000;47:419–25.PubMedCrossRefGoogle Scholar
  9. 9.
    Chocolate. Available at http://en.wikipedia.org/wiki/Chocolate. Accessed on May 5 th. 2011.
  10. 10.
    Patel J, D’Souza J. Can we now eat chocolate without feeling guilty? J Am Pharm Assoc. 2008;48:438–40.CrossRefGoogle Scholar
  11. 11.
    Lee KW, Kim YJ, Lee HJ, Lee CY. Cocoa has more phenolic phytochemicals and a higher antioxidant capacity than teas and red wine. J Agric Food Chem. 2003;51:7292–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Lee KW, Kim YJ, Lee HJ, Lee CY. Cocoa has more phenolic phytochemicals and a higher antioxidant capacity than teas and red wine. J Agric Food Chem. 2003;51:7292–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Gu L, House SE, Wu X, Ou B, Prior RL. Procyanidin and catechin contents and antioxidant capacity of cocoa and chocolate products. J Agric Food Chem. 2006;54:4057–61.PubMedCrossRefGoogle Scholar
  14. 14.
    Steinberg FM, Bearden MM, Keen CL. Cocoa and chocolate flavonoids: implications for cardiovascular health. J Am Diet Assoc. 2003;103:215–23.PubMedCrossRefGoogle Scholar
  15. 15.
    Schini-Kerth VB, Auger C, Kim JH, Etienne-Selloum N, Chataigneau T. Nutritional improvement of the endothelial control of vascular tone by polyphenols: role of NO and EDHF. Pflugers Arch. 2010;459:853–62.PubMedCrossRefGoogle Scholar
  16. 16.
    Fisher ND, Hughes M, Gerhard-Herman M, Hollenberg NK. Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans. J Hypertens. 2003;21:2281–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Karim M, McCormick K, Kappagoda CT. Effects of cocoa extracts on endothelium-dependent relaxation. J Nutr. 2000;130(8S Suppl):2105S–8S.PubMedGoogle Scholar
  18. 18.
    Grassi D, Desideri G, Necozione S, et al. Blood pressure is reduced and insulin sensitivity increased in glucose-intolerant, hypertensive subjects after 15 days of consuming high-polyphenol dark chocolate. J Nutr. 2008;138:1671–6.PubMedGoogle Scholar
  19. 19.
    Ried K, Sullivan T, Fakler P, Frank OR, Stocks NP. Does chocolate reduce blood pressure? A meta-analysis BMC Medicine. 2010;8:39.Google Scholar
  20. 20.
    Jia L, Liu X, Bai YY, et al. Short-term effect of cocoa product consumption on lipid profile: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2010;92:218–25.PubMedCrossRefGoogle Scholar
  21. 21.
    Mellor DD, Sathyapalan T, Kilpatrick ES, Beckett S, Atkin SL. High-cocoa polyphenol-rich chocolate improves HDL cholesterol in Type 2 diabetes patients. Diabet Med. 2010;27:1318–21.PubMedCrossRefGoogle Scholar
  22. 22.
    Davison K, Coates AM, Buckley JD, Howe PR. Effect of cocoa flavanols and exercise on cardiometabolic risk factors in overweight and obese subjects. Int J Obes. 2008;32:1289–96.CrossRefGoogle Scholar
  23. 23.
    Pearson DA, Paglieroni TG, Rein D, et al. The effects of flavanol-rich cocoa and aspirin on ex vivo platelet function. Thromb Res. 2002;106:191–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Innes AJ, Kennedy G, McLaren M, Bancroft AJ, Belch JJ. Dark chocolate inhibits platelet aggregation in healthy volunteers. Platelets. 2003;14:325–7.PubMedCrossRefGoogle Scholar
  25. 25.
    • Djoussé L, Hopkins PN, North KE, et al: Chocolate consumption is inversely associated with prevalent coronary heart disease: The National Heart, Lung, and Blood Institute Family Heart Study. Clin Nutr 2011, 30:182–187. This large cross-sectional analysis among 25- to 93-year-old study participants showed an inverse relation between chocolate consumption and prevalent coronary heart disease and a 49% increased prevalence odds of coronary disease among people consuming non-chocolate candy.PubMedCrossRefGoogle Scholar
  26. 26.
    •• Lewis JR, Prince RL, Zhu K, et al: Habitual Chocolate Intake and Vascular Disease: A Prospective Study of Clinical Outcomes in Older Women. Arch Intern Med 2010, 170:1857–1858. This prospective study demonstrated that frequent chocolate intake was associated with a lower risk of hospitalization for ischemic heart disease and heart failure or death in older women.PubMedCrossRefGoogle Scholar
  27. 27.
    Shiina Y, Funabashi N, Lee K, et al. Acute effect of oral flavonoid-rich dark chocolate intake on coronary circulation, as compared with non-flavonoid white chocolate, by transthoracic Doppler echocardiography in healthy adults. Int J Cardiol. 2009;131:424–9.PubMedCrossRefGoogle Scholar
  28. 28.
    •• Djoussé L, Hopkins PN, Arnett DK, et al: Chocolate consumption is inversely associated with calcified atherosclerotic plaque in the coronary arteries: The NHLBI Family Heart Study. Clin Nutr 2011, 30:38–43. This study showed for the first time an inverse association between chocolate consumption and subclinical atherosclerosis (coronary artery calcium).PubMedCrossRefGoogle Scholar
  29. 29.
    •• Janszky I, Mukamal KJ, Ljung R,et al: Chocolate conusmption and mortality following a first acute myocardial infarction: the Stockholm Heart Epidemiology Program. J Intern Med 2009, 266:248–257. In this cohort study of 1169 non-diabetic patients who suffered non-fatal myocardial infarction, chocolate consumption was associated with a lower risk of mortality in a dose-dependent manner, with nearly 70% lower risk of death in people consuming chocolate 2 or more times per week. PubMedCrossRefGoogle Scholar
  30. 30.
    Arts IC, Jacobs Jr DR, Harnack LJ, Gross M, Folsom AR. Dietary catechins in relation to coronary heart disease death among postmenopausal women. Epidemiology. 2001;12:668–75.PubMedCrossRefGoogle Scholar
  31. 31.
    Buijsse B, Feskens EJ, Kok FJ, Kromhout D. Cocoa intake, blood pressure, and cardiovascular mortality: the Zutphen elderly study. Arch Intern Med. 2006;166:411–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Mink PJ, Scrafford CG, Barraj LM, et al. Flavonoid intake and cardiovascular disease mortality: a prospective study in postmenopausal women. Am J Clin Nutr. 2007;85:895–909.PubMedGoogle Scholar
  33. 33.
    Bayard V, Chamorro F, Motta J, Hollenberg NK. Does flavanol intake influence mortality from nitric oxide-dependent processes? Ischemic heart disease, stroke, diabetes mellitus, and cancer in Panama. Int J Med Sci. 2007;4:53–8.PubMedGoogle Scholar
  34. 34.
    Ross E (30 August 2004): Dark Chocolate Could Help Hearts. CBS News. Available at http://www.cbsnews.com/stories/2004/08/30/health/main639325.shtml. Accessed 29 th. May 2008.
  35. 35.
    Fisher ND, Hollenberg NK. Aging and vascular responses to flavanol-rich cocoa. J Hypertens. 2006;24:1575–80.PubMedCrossRefGoogle Scholar
  36. 36.
    Heiss C, Jahn S, Taylor M, et al. Improvement of endothelial function with dietary flavanols is associated with mobilization of circulating angiogenic cells in patients with coronary artery disease. J Am Coll Cardiol. 2010;56:218–24.PubMedCrossRefGoogle Scholar
  37. 37.
    Panneerselvam M, Tsutsumi YM, Bonds JA, et al. Dark chocolate receptors: epicatechin-induced cardiac protection is dependent on {delta}-opioid receptor stimulation. Am J Physiol Heart Circ Physiol. 2010;299:H1604–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Corti R, Flammer AJ, Hollenberg NK, Lusche TF. Cocoa and cardiovascular health. Circulation. 2009;119:1433–41.PubMedCrossRefGoogle Scholar
  39. 39.
    Selmi C, Cocchi CA, Lanfredini M, Keen CL, Gershwin ME. Chocolate at heart: the anti-inflammatory impact of cocoa flavanols. Mol Nutr Food Res. 2008;52:1340–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Ried K, Frank O, Stocks N. Dark chocolate or tomato extract for prehypertension: a randomised controlled trial. BMC Complement Altern Med. 2009;9:22.PubMedCrossRefGoogle Scholar
  41. 41.
    Persson IA, Persson K, Hägg S, Andersson RG: Effects of Cocoa Extract and Dark Chocolate on Angiotensin-Converting Enzyme and Nitric Oxide in Human Endothelial Cells and Healthy Volunteers. J Cardiovasc Pharmacol 2010, In press.Google Scholar
  42. 42.
    •• Tokede OA, Gaziano JM, Djousse L: Effects of cocoa products/dark chocolate on serum lipids: A meta-analysis. Eur J Clin Nutr 2011, In press. This recent meta-analysis demonstrated beneficial effects of dark chocolate/cocoa products on total and LDL cholesterol and no major effects on HDL cholesterol and triglycerides.Google Scholar
  43. 43.
    Grassi D, Lippi C, Necozione S, Desideri G, Ferri C. Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Am J Clin Nutr. 2005;81:611–4.PubMedGoogle Scholar
  44. 44.
    di Giuseppe R, Di Castelnuovo A, Centritto F, et al. Regular consumption of dark chocolate is associated with low serum concentrations of C-reactive protein in a healthy Italian population. J Nutr. 2008;138:1939–45.PubMedGoogle Scholar
  45. 45.
    Monagas M, Khan N, Andres-Lacueva C, et al. Effect of cocoa powder on the modulation of inflammatory biomarkers in patients at high risk of cardiovascular disease. Am J Clin Nutr. 2009;90:1144–50.PubMedCrossRefGoogle Scholar
  46. 46.
    Holt RR, Schramm DD, Keen CL, Lazarus SA, Schmitz HH. Chocolate consumption and platelet function. JAMA. 2002;287:2212–3.PubMedCrossRefGoogle Scholar
  47. 47.
    Rein D, Paglieroni TG, Wun T, et al. Cocoa inhibits platelet activation and function. Am J Clin Nutr. 2000;72:30–5.PubMedGoogle Scholar
  48. 48.
    Kelly FD, Sinclair AJ, Mann NJ, et al. A stearic acid-rich diet improves thrombogenic and atherogenic risk factor profiles in healthy males. Eur J Clin Nutr. 2001;55:88–96.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Owais Khawaja
    • 1
    • 3
  • J. Michael Gaziano
    • 1
    • 2
    • 3
    • 4
  • Luc Djoussé
    • 1
    • 2
    • 3
  1. 1.Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC)Boston Veterans Affairs Healthcare SystemBostonUSA
  2. 2.Geriatric Research, Education, and Clinical Center (GRECC)Boston Veterans Affairs Healthcare SystemBostonUSA
  3. 3.Divisions of AgingBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  4. 4.Division of Preventive MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA

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