Current Hypertension Reports

, Volume 8, Issue 3, pp 205–211 | Cite as

Effect of dark chocolate on arterial function in healthy individuals: Cocoa instead of ambrosia?

  • Charalambos Vlachopoulos
  • Nikolaos Alexopoulos
  • Christodoulos Stefanadis
Article

Abstract

Cocoa has been consumed for at least 2500 years, and for long time it has been regarded as a medicine. Arterial function is of paramount importance for the proper function and integrity of the cardiovascular system. Dark chocolate and flavonoid-rich cocoa have beneficial acute and shortterm effects on endothelial function and wave reflections in normal individuals, in adults with cardiovascular risk factors, and in patients with coronary artery disease. Furthermore, dark chocolate and flavonoid-rich cocoa may have a blood pressure-lowering effect. These effects can be attributed to flavonoids and are mainly mediated through increased nitric oxide bioavailability. Further research is needed to demonstrate whether these effects of chocolate on arterial function are translated into clinical benefit.

References and Recommended Reading

  1. 1.
    Hurst WJ, Tarka SM Jr, Powis TG, et al.: Cacao usage by the earliest Maya civilization. Nature 2002, 418:289–290.PubMedCrossRefGoogle Scholar
  2. 2.
    Dillinger TL, Barriga P, Escarcega S, et al.: Food of the gods: cure for humanity? A cultural history of the medicinal and ritual use of chocolate. J Nutr 2000, 130:2057S-2072S. A very interesting article with ample historical data on the medicinal use of chocolate.PubMedGoogle Scholar
  3. 3.
    Ferri C, Grassi G: Mediterranean diet, cocoa and cardiovascular disease: a sweeter life, a longer life, or both? J Hypertens 2003, 21:2231–2234.PubMedCrossRefGoogle Scholar
  4. 4.
    Wang JF, Schramm DD, Holt RR, et al.: A dose-response effect from chocolate consumption on plasma epicatechin and oxidative damage. J Nutr 2000, 130:2115S-2119S.PubMedGoogle Scholar
  5. 5.
    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, 51:7292–7295.PubMedCrossRefGoogle Scholar
  6. 6.
    Stensvold I, Tverdal A, Solvoll K, Per Foss O: Tea consumption. Relationship to cholesterol, blood pressure, and coronary and total mortality. Prev Med 1992, 21:546–553.PubMedCrossRefGoogle Scholar
  7. 7.
    Hertog MG, Feskens EJ, Hollman PC, et al.: Dietary antioxidant flavonoids and risk of coronary heart disease: the Zutphen Elderly Study. Lancet 1993, 342:1007–1011.PubMedCrossRefGoogle Scholar
  8. 8.
    Knekt P, Jarvinen F, Reunanen A, Maatela J: Flavonoid intake and coronary mortality in Finland: a cohort study. BMJ 1996, 125:384–389.Google Scholar
  9. 9.
    Hollenberg NK, Schmitz H, MacDonald I, Poulter N: Cocoa, flavanols and cardiovascular risk. Br J Cardiol 2004, 11:379–386.CrossRefGoogle Scholar
  10. 10.
    Taubert D, Berkels R, Roesen R, Klaus W: Chocolate and blood pressure in elderly individuals with isolated systolic hypertension. JAMA 2003, 290:1029–1030.PubMedCrossRefGoogle Scholar
  11. 11.
    Celermajer DS, Sorensen KE, Gooch VM, et al.: Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992, 340:1111–1115.PubMedCrossRefGoogle Scholar
  12. 12.
    Heitzer T, Schlinzig T, Krohn K, et al.: Endothelial dysfunction, oxidative stress, and risk of cardiovascular events in patients with coronary artery disease. Circulation 2001, 104:2673–2678.PubMedGoogle Scholar
  13. 13.
    Wilkinson IB, Franklin SS, Cockcroft JR: Nitric oxide and the regulation of large artery stiffness. From physiology to pharmacology. Hypertension 2004, 44:112–116.PubMedCrossRefGoogle Scholar
  14. 14.
    Stefanadis C, Dernellis J, Tsiamis E, et al.: Aortic stiffness is a risk factor for recurrent acute coronary events in patients with ischaemic heart disease. Eur Heart J 2000, 21:390–396.PubMedCrossRefGoogle Scholar
  15. 15.
    Vlachopoulos C, O’Rourke MF: Genesis of the normal and abnormal arterial pulse. Curr Probl Cardiol 2000, 25:297–368.CrossRefGoogle Scholar
  16. 16.
    Vlachopoulos C, Aznaouridis K, Stefanadis C: Clinical appraisal of arterial stiffness: the Argonauts in front of the Golden Fleece. Heart 2005, Epub ahead of print.Google Scholar
  17. 17.
    Vlachopoulos C, Tsekoura D, Alexopoulos N, et al.: Type 5 phosphodiesterase inhibition by sildenafil abrogates acute smoking-induced endothelial dysfunction. Am J Hypertens 2004, 17:1040–1044.PubMedCrossRefGoogle Scholar
  18. 18.
    Vlachopoulos C, Kosmopoulou F, Panagiotakos D, et al.: Smoking and caffeine have a synergistic detrimental effect on aortic stiffness and wave reflections. J Am Coll Cardiol 2004, 44:1911–1917.PubMedCrossRefGoogle Scholar
  19. 19.
    Fisher ND, Hughes M, Gerhard-Herman M, Hollenberg NK: Flavonol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans. J Hypertens 2003, 21:2281–2286. The first study of cocoa in healthy subjects. It showed that cocoa resulted in a nitric oxide-dependent vasodilation and that this was mainly, but not exclusively, due to the presence of flavonoids.PubMedCrossRefGoogle Scholar
  20. 20.
    Engler MB, Engler MM, Chen CY, et al.: Flavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adults. J Am Coll Nutr 2004, 23:197–204.PubMedGoogle Scholar
  21. 21.
    Vlachopoulos C, Aznaouridis K, Alexopoulos N, et al.: Effect of dark chocolate on arterial function in healthy individuals. Am J Hypertens 2005, 18:785–791. The only study until now to investigate the effect of dark chocolate on arterial stiffness and wave reflections on healthy individuals.PubMedCrossRefGoogle Scholar
  22. 22.
    Heiss C, Kleinbongard P, Dejam A, et al.: Acute consumption of flavanol-rich cocoa and the reversal of endothelial dysfunction in smokers. J Am Coll Cardiol 2005, 46:1276–1283. This study provides evidence that one of the main mechanisms involved in the beneficial effect of cocoa on endothelial function is the increase in the bioavailability of nitric oxide.PubMedCrossRefGoogle Scholar
  23. 23.
    Hermann F, Spieker LE, Ruschitzka F, et al.: Dark chocolate improves endothelial and platelet function. Heart 2006, 92:119–120. An interesting study that showed that the beneficial effect of dark chocolate on endothelial function lasted for at least 8 hours. Furthermore, a beneficial effect on platelet function was also observed.PubMedCrossRefGoogle Scholar
  24. 24.
    Grassi D, Necozione S, Lippi C, et al.: Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives. Hypertension 2005, 46:398–405. An interesting study showing a blood pressure-lowering and metabolic effect in hypertensive subjects.PubMedCrossRefGoogle Scholar
  25. 25.
    Heiss C, Dejam A, Schewe T, et al.: Vascular effects of coca rich in flavan-3-ols. JAMA 2003, 290:1030–1031.PubMedCrossRefGoogle Scholar
  26. 26.
    Hollenberg NK, Martinez G, McCullough M, et al.: Aging, acculturation, salt intake, and hypertension in the Kuna of Panama. Hypertension 1997, 29:171–176. An interesting population to study that shows no increase of blood pressure with age, due to environmental factors, possibly the cocoa drink, rich in flavonoids, that they consume in large amounts.PubMedGoogle Scholar
  27. 27.
    Chevaux KA, Jackson L, Villar ME, et al.: Proximate, mineral and procyanidin content of certain foods and beverages consumed by the Kuna Amerinds of Panama. J Food Compos Anal 2001, 14:553–668.CrossRefGoogle Scholar
  28. 28.
    Buijsse B, Feskens EJM, Streppel MT, et al.: Chocolate consumption and blood pressure in elderly men: the Zutphen Elderly Study [abstract]. Eur Heart J 2004, 25:235.Google Scholar
  29. 29.
    Alonso A, de la Fuente C, Beunza JJ, et al.: Chocolate consumption and incidence of hypertension. Hypertension 2005, 46:e21-e22.PubMedCrossRefGoogle Scholar
  30. 30.
    Grassi D, Lippi C, Necozione S, et al.: 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, 81:611–614.PubMedGoogle Scholar
  31. 31.
    Fraga CG, Actis-Goretta L, Ottaviani JI, et al.: Regular consumption of a flavanol-rich chocolate can improve oxidant stress in young soccer players. Clin Dev Immunol 2005, 12:11–17.PubMedCrossRefGoogle Scholar
  32. 32.
    Serafini M, Bugianesi R, Maiani G, et al.: Plasma antioxidants from chocolate. Nature 2003, 424:1013. This study demonstrated in the most convincing way that milk, both in chocolate or consumed with it, prevents chocolate flavonoids from being absorbed.PubMedCrossRefGoogle Scholar
  33. 33.
    Schramm DD, Wang JF, Holt RR, et al.: Chocolate procyanidins decrease the leukotriene-prostacyclin ratio in humans and human aortic endothelial cells. Am J Clin Nutr 2001, 73:36–40.PubMedGoogle Scholar
  34. 34.
    Mursu J, Voutilainen S, Nurmi T, et al.: Dark chocolate consumption increases HDL cholesterol concentration and chocolate fatty acids may inhibit lipid peroxidation in healthy humans. Free Radic Biol Med 2004, 37:1351–1359.PubMedCrossRefGoogle Scholar
  35. 35.
    Karim M, McCormick K, Kappagoda T: Effects of cocoa extracts on endothelium-dependent relaxation. J Nutr 2000, 130:2105S-2108S.PubMedGoogle Scholar
  36. 36.
    Actis-Goretta L, Ottaviani JI, Fraga CG: Inhibition of angiotensin converting enzyme activity by flavanol-rich foods. J Agric Food Chem 2006, 54:229–234.PubMedCrossRefGoogle Scholar
  37. 37.
    Innes AJ, Kennedy G, McLaren M, et al.: Dark chocolate inhibits platelet aggregation in healthy volunteers. Platelets 2003, 14:325–327.PubMedCrossRefGoogle Scholar
  38. 38.
    Hingorani AD, Cross J, Kharbanda RK, et al.: Acute systemic inflammation impairs endothelium dependent dilatation in humans. Circulation 2000, 102:994–999.PubMedGoogle Scholar
  39. 39.
    Vlachopoulos C, Dima I, Aznaouridis K, et al.: Acute systemic inflammation increases arterial stiffness and decreases wave reflections in healthy individuals. Circulation 2005, 112:2193–2200.PubMedCrossRefGoogle Scholar
  40. 40.
    Davda RK, Stepniakowski KT, Lu G, et al.: Oleic acid inhibits endothelial nitric oxide synthase by a protein kinase C-independent mechanism. Hypertension 1995, 26:764–770.PubMedGoogle Scholar
  41. 41.
    Vlachopoulos C, Panagiotakos D, Ioakeimidis N, et al.: Chronic coffee consumption has a detrimental effect on aortic stiffness and wave reflections. Am J Clin Nutr 2005, 81:1307–1312.PubMedGoogle Scholar
  42. 42.
    Vlachopoulos C, Alexopoulos N, Dima I, et al.: Acute effect of black and green tea on aortic stiffness and wave reflections. J Am Coll Nutr 2006, In press.Google Scholar
  43. 43.
    Meisel P: Hypertension, diabetes: chocolate with a single remedy? Hypertension 2005, 46:e17.PubMedCrossRefGoogle Scholar
  44. 44.
    Duffy SJ, Keaney JF Jr, Holbrook M, et al.: Short- and long-term black tea consumption reverses endothelial dysfunction in patients with coronary artery disease. Circulation 2001, 104:151–156.PubMedGoogle Scholar
  45. 45.
    Agewall S, Wright S, Doughty RN, et al.: Does a glass of red wine improve endothelial function? Eur Heart J 2000, 21:74–78.PubMedCrossRefGoogle Scholar
  46. 46.
    Karatzi KN, Papamichael CM, Karatzis EN, et al.: Red wine acutely induces favorable effects on wave reflections and central pressures in coronary artery disease patients. Am J Hypertens 2005, 18:1161–1167.PubMedCrossRefGoogle Scholar
  47. 47.
    Fuentes F, Lopez-Miranda J, Sanchez E, et al.: Mediterranean and low-fat diets improve endothelial function in hypercholesterolemic men. Ann Intern Med 2001, 134:1115–1119.PubMedGoogle Scholar
  48. 48.
    Esposito K, Marfella R, Ciotola M, et al.: Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004, 292:1440–1446.PubMedCrossRefGoogle Scholar
  49. 49.
    Teede H, McGrath B, DeSilva L, et al.: Isoflavones reduce arterial stiffness. A placebo-controlled study in men and postmenopausal women. Arterioscler Thromb Vasc Biol 2003, 23:1066–1071.PubMedCrossRefGoogle Scholar
  50. 50.
    NCEP: Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Final Report. Bethesda, MD: National Heart, Lung, and Blood Institute; 2002. Available at: http://www.nhlbi.nih. gov/guidelines/cholesterol/atp3full.pdf.Google Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  • Charalambos Vlachopoulos
    • 1
  • Nikolaos Alexopoulos
  • Christodoulos Stefanadis
  1. 1.Hypertension Unit and Peripheral Vessels Unit, 1st Cardiology DepartmentAthens Medical SchoolAthensGreece

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