Skip to main content

Cocoa flavanols and cardiovascular health

Phytochemistry Reviews volume 1, pages 231–240 (2002)Cite this article

Abstract

Fruits and vegetables have historically been considered rich sources of essential dietary micronutrients, soluble fiber, and antioxidants. More recently they are have been recognized as important sources for a wide array of phytochemicals that individually, or in combination, may benefit vascular health. Flavonoids are the largest, and most widely distributed class of phytochemicals, and can be further subdivided into several different sub-classes. Several epidemiology studies have observed an inverse association between flavonoid intake and risk of cardiovascular mortality. One sub-class of flavonoids, the flavanols, is found in foods such as grapes, red wine, tea, cocoa and chocolate; however, it is important to note that common food processing practices can significantly reduce the levels of these compounds found in finished food products. Recent studies have examined the potential of flavanol-rich cocoa and chocolates to influence vascular health. In this review, we discuss evidence for the hypothesis that the consumption of flavanol-rich cocoa can reduce the risk for cardiovascular disease through a multiplicity of mechanisms, including changes in oxidant defense mechanisms, vascular reactivity, cytokine production, and platelet function.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  • Adamson GE, Lazarus SA, Mitchell AE, Prior RL, Cao G, Jacobs PH, Kremers BG, Hammerstone JF, Rucker RB, Ritter KA & Schmitz HH (1999) HPLC method for the quantification of procyanidins in cocoa and chocolate samples and correlation to total antioxidant capacity. J. Agric. Food Chem. 47: 4184-4188.

    PubMed  CAS  Article  Google Scholar 

  • Andriambeloson E, Magnier C, Haan-Archipoff G, Lobstein A, Anton R, Beretz A, Stoclet JC & Andriantsitohaina R (1998) Natural dietary polyphenolic compounds cause endotheliumdependent vasorelaxation in rat thoracic aorta. J. Nutr. 128: 2324-2333.

    PubMed  CAS  Google Scholar 

  • Arteel GE, Schroeder P & Sies H (2000) Reactions of peroxynitrite with cocoa procyanidin oligomers. J. Nutr. 130: 2100S-2104S.

    PubMed  CAS  Google Scholar 

  • Arteel GE & Sies H (1999) Protection against peroxynitrite by cocoa polyphenol oligomers. FEBS Lett. 462: 167-170.

    PubMed  CAS  Article  Google Scholar 

  • Arts I, Hollman P, Feskens E, Bueno de Mesquita H & Kromhout D (2001) Catechin intake might explain the inverse relation between tea consumption and ischemic heart disease: The Zutphen Elderly Study. Am. J. Clin. Nutr. 74: 227-232.

    PubMed  CAS  Google Scholar 

  • Arts IC, Jacobs DR Jr., Gross M, Harnack LJ & Folsom AR (2002) Dietary catechins and cancer incidence among postmenopausal women: the Iowa Women's Health Study (United States). Cancer Causes Control 13: 373-382.

    PubMed  Article  Google Scholar 

  • Baba S, Osakabe N, Natsume M & Terao J (2002) Absorption and urinary excretion of procyanidin B2 [epicatechin-(4?-8)-epicatechin] in rats. Free Radic. Biol. Med. 33: 142-148.

    PubMed  CAS  Article  Google Scholar 

  • Baba S, Osakabe N, Natsume M, Yasuda A, Takizawa T, Nakamura T & Terao J (2000a) Cocoa powder enhances the level of antioxidative activity in rat plasma. Br. J. Nutr. 84: 673-680.

    PubMed  CAS  Google Scholar 

  • Baba S, Osakabe N, Yasuda A, Natsume M, Takizawa T, Nakamura T & Terao J (2000b) Bioavailability of (-)-Epicatechin upon intake of chocolate and cocoa in human volunteers. Free Rad. Res. 33: 635-641.

    CAS  Google Scholar 

  • Bhagwat S, Beecher GR, Haytowitz D, Holden J, Gebhardt S, Dwyer J, Peterson J & Eldridge A (2002) Development of a Database for Flavonoids in Foods. Poster presented at 26th National Nutrient Data Bank Conference. Baton Rouge, LA, USA.

  • Bearden MM, Pearson DA, Rein D, Chevaux KA, Carpenter DR, Keen CL & Schmitz H (2000) Potential cardiovascular health benefits of procyanidins present in chocolate and cocoa. In: Parliment TH, Ho C-T & Schieberle P (eds) Caffeinated Beverages: Health Benefits, Physiological Effects, and Chemistry. (pp. 177-186). American Chemical Society, Washington, DC.

    Google Scholar 

  • Becker B, Heindl B, Kupatt C & Zahler S (2000) Endothelial function and hemostasis. Z. Kardiol. 89: 160-167.

    PubMed  CAS  Google Scholar 

  • Borchers A, Keen CL, Hannum S & Gershwin ME (2000) Cocoa and chocolate: Composition, bioavailability, and health implications. J. Med. Foods 3: 77-105.

    CAS  Article  Google Scholar 

  • Bordoni A, Hrelia S, Angeloni C, Giordano E, Guarnieri C, Caldarerea CM & Biagi PL (2002) Green tea protection of hypoxia/reoxygenation injury in cultured cardiac cells. J. Nutr. Biochem. 13: 103-111.

    PubMed  CAS  Article  Google Scholar 

  • Bravo L (1998) Polyphenols: Chemistry, dietary sources, metabolism and nutritional significance. Nutr. Rev. 56: 317-333.

    PubMed  CAS  Article  Google Scholar 

  • Brunet MJ, Blade C, Salvado MJ & Arola L (2002) Human apo A-I and rat transferrin are the principal plasma proteins that bind wine catechins. J. Agric. Food Chem. 50: 2708-2712.

    PubMed  CAS  Article  Google Scholar 

  • Cai H & Harrison DG (2000) Endothelial dysfunction in cardiovascular disease. The role of oxidant stress. Circ. Res. 87: 840-844.

    PubMed  CAS  Google Scholar 

  • Cao Y, Cao R & Brakenhielm E (2002) Antiangiogenic mechanisms of diet-derived polyphenols. J. Nutr. Biochem. 13: 380-390.

    PubMed  CAS  Article  Google Scholar 

  • Carr A, McCall MR & Frei B (2000) Oxidation of LDL by myeloperoxidase and reactive nitrogen species. Reaction pathways and antioxidant protection. Arterioscler. Thromb. Vasc. Biol. 20: 1716-1723.

    PubMed  CAS  Google Scholar 

  • Chang W-C & Hsu F-L (1989) Inhibition of platelet aggregation and arachidonate metabolism in platelets by procyanidins. Prostaglandins Leukot Essent Fatty Acids 38: 181-188.

    PubMed  CAS  Article  Google Scholar 

  • Chiu D, Lubin B & Shohet S (1982) Peroxidative reactions in red cell biology. In: Pryor W (ed) Free Radicals in Biology. Vol V. (pp. 115-160). Academic Press, New York.

    Google Scholar 

  • Chow JM, Liu JC, Che YJ, Hsieh MH, Kao PF, Cheng JJ & Chan P (2002) The effects of catechin on superoxide dismutase activity and its gene expression in pheochromocytoma cells. Zhonghua Yi Xue Za Zhi (Taipei) 65: 138-143.

    Google Scholar 

  • Colman RW, Clowes AW, George JN, Hirsch J & Marder VJ (2001) Overview of hemostasis. In: Colman RW, Hirsh J, Marder VJ, Clowes AW & George JN (eds) Hemostasis and thrombosis: basic principles and clinical practice. (pp. 3-16). Lippincott Williams & Wilkins, New York.

    Google Scholar 

  • Dillinger TL, Barriga P, Escarcega S, Jimenez M, Lowe DS & Grivetti LE (2000) Food of the gods: Cure for humanity? A cultural history of the medicinal and ritual use of chocolate. J. Nutr. 130: 2057S-2072S.

    PubMed  CAS  Google Scholar 

  • Donovan JL, Crespy V, Manach C, Morand C, Besson C, Scalbert A & Remesy C (2001) Catechin is metabolized by both the small intestine and liver of rats. J. Nutr. 131: 1753-1757.

    PubMed  CAS  Google Scholar 

  • Dusinska M, Vallova B, Ursinyova M, Hladikova V, Smolkova B, Wsolova L, Raslova K & Collins AR (2002) DNA damage and antioxidants; fluctuations through the year in a central European population group. Food Chem. Toxicol. 40: 1119-1123.

    PubMed  CAS  Article  Google Scholar 

  • Farquharson CA, Butler R, Hill A, Belch JJ & Struthers AD (2002) Allopurinol improves endothelial dysfunction in chronic heart failure. Circulation 106: 221-226.

    PubMed  CAS  Article  Google Scholar 

  • Freedman JE, Parker III C, Li L, Perlman JA, Frei B, Ivanov V, Deak LR, Iafrati MD & Folts J (2001) Select flavonoids and whole juice from purple grapes inhibit platelet function and enhance nitric oxide release. Circulation 103: 2792-2798.

    PubMed  CAS  Google Scholar 

  • Geleijnse JM, Launer LJ, Hofman A, Pols HA & Witteman JC (1999) Tea flavonoids may protect against atherosclerosis: The Rotterdam Study. Arch. Intern. Med. 159: 2170-2174.

    PubMed  CAS  Article  Google Scholar 

  • Haslam E (1998) Practical polyphenolics: From structure to molecular recognition and physiological action. (pp. 178-225, 335-373). Cambridge University Press, New York.

    Google Scholar 

  • Hannum SM & Erdman JJW (2000) Emerging health benefits from cocoa and chocolate. J. Med. Food 3: 73-75.

    CAS  Article  Google Scholar 

  • Hertog MG, Kromhout D, Aravanis C, Blackburn H, Buzina R, Fidanza F, Giampaoli S, Jansen A, Menotti A, Nedeljkovic S, Pekkarinen M, Simic BS, Toshima H, Feskens EJ, Hollman PC & Katan MB (1995) Flavonoid intake and long-term risk of coronary heart disease and cancer in the Seven Countries Study. Arch. Intern. Med. 155: 381-386.

    PubMed  CAS  Article  Google Scholar 

  • Higashi Y, Sasaki S, Nakagawa K, Matsuura H, Oshima T & Chayama K (2002) Endothelial function and oxidative stress in renovascular hypertension. N. Engl. J. Med. 346: 1954-1962.

    PubMed  CAS  Article  Google Scholar 

  • Hiipakka RA, Zhang HZ, Dai W, Dai Q & Liao S (2002) Structure-activity relationships for inhibition of human 5-alpha-reductases by polyphenols. Biochem. Pharmacol. 63: 1165-1176.

    PubMed  CAS  Article  Google Scholar 

  • Hollman PC (2001) Evidence for health benefits of plant phenols: local or systemic effects? J. Sci. Food Agric. 81: 842-852.

    CAS  Article  Google Scholar 

  • Holt RR, Lazarus SA, Sullards M, Zhu Q, Schramm DD, Hammerstone JF, Fraga CG, Schmitz H & Keen CL (2002a) Procyanidin dimer B2 (epicatechin-(4?-8)-epicatechin) in human plasma after the consumption of a flavanol-rich cocoa. Am. J. Clin. Nutr. 76: 798-804.

    PubMed  CAS  Google Scholar 

  • Holt RR, Schramm DD, Keen CL, Lazarus SA & Schmitz H (2002b) Flavonoid-rich chocolate and platelet function. JAMA 287: 2212-2213.

    PubMed  Article  Google Scholar 

  • Huang Y, Chan NW, Lau CW, Yao XQ, Chan FL & Chen ZY (1999) Involvement of endothelium/ nitric oxide in vasorelaxation induced by purified green tea (-)-epicatechin. Biochim. Biophys. Acta 1427: 322-328.

    PubMed  CAS  Google Scholar 

  • Hurst WJ, Tarka SM Jr., Powis TG, Valdez Jr. F & Hester TR (2002) Cacao usage by the earliest Maya civilization. Nature 418: 289-290.

    PubMed  CAS  Article  Google Scholar 

  • Jimenez-Ramsey L, Rogler J, Housley T, Butler L & Elikin R (1994) Absorption and distribution of 14C-labeled condensed tannins and related sorghum phenolics in chickens. J. Agric. Food Chem. 42: 963-967.

    CAS  Article  Google Scholar 

  • Joshipura KJ, Hu FB, Manson JE, Stampfer MJ, Rimm EB, Speizer FE, Colditz G, Ascherio A, Rosner B, Spiegelman D & Willett WC (2001) The effect of fruit and vegetable intake on risk for coronary heart disease. Ann. Intern. Med. 134: 1106-1114.

    PubMed  CAS  Google Scholar 

  • Karim M, McCormick K & Kappagoda CT (2000) Effects of cocoa procyanidins on endothelium-dependent relaxation. J. Nutr. 130: 2105S-2108S.

    PubMed  CAS  Google Scholar 

  • Kim H & Keeney P (1984) (-)-Epicatechin content in fermented and unfermented cocoa beans. J Food Sci 49: 1090-1092.

    CAS  Google Scholar 

  • Kondo K, Hirano R, Matsumoto A, Igarashi O & Itakura H (1996) Inhibition of LDL oxidation by cocoa. Lancet 348: 1514.

    PubMed  CAS  Article  Google Scholar 

  • Kris-Etherton P & Keen CL (2002) Evidence that the antioxidant flavonoids in tea and cocoa are beneficial for cardiovascular health. Curr. Opin. Lipidol. 13: 41-49.

    PubMed  CAS  Article  Google Scholar 

  • Kuhnle G, Spencer JP, Schroeter H, Shenoy B, Debnam E, Srai SK, Rice-Evans C & Hahn U (2000) Epicatechin and catechin are omethylated and glucuronidated in the small intestine. Biochem. Biophys. Res. Commun. 277: 507-512.

    PubMed  CAS  Article  Google Scholar 

  • Lampe JW (1999) Health effects of vegetables and fruit: Assessing mechanisms of action in human experimental studies. Am. J. Clin. Nutr. 70: 475S-490S.

    PubMed  CAS  Google Scholar 

  • Laparra J, Michaud J & Masquelier J (1977) Etude pharmacocinetique des oligomeres flavanoliques. Plant Med. Phytother. 11: 133-142.

    CAS  Google Scholar 

  • Lee M-J, Wang Z-Y, Li H, Chen L, Sun Y, Gobbo S, Balentine D & Yang CS (1995) Analysis of plasma and urinary tea polyphenols in human subjects. Cancer Epid. Biomar. Prev. 4: 393-399.

    CAS  Google Scholar 

  • Libby P (2000) Changing concepts of atherogenesis. J. Int. Med. 247: 349-358.

    CAS  Article  Google Scholar 

  • Lotito SB, Actis-Goretta L, Renart L, Caligiuri M, Rein D, Schmitz HH, Steinberg FM, Keen CL & Fraga CG (2000) Influence of oligomer chain length on the antioxidant activity of procyanidins. Biochem. Biophys. Res. Commun. 276: 945-951.

    PubMed  CAS  Article  Google Scholar 

  • Mao T, Powell J, Van de Water J, Keen CL, Schmitz H & Gershwin M (1999) The influence of cocoa procyanidins on the transcription of interleukin-2 in peripheral blood mononuclear cells. Int. J. Immunotherapy 15: 23-29.

    CAS  Google Scholar 

  • Mao T, Powell J, Van De Water J, Keen CL, Schmitz H & Gershwin M (2000a) Effect of cocoa procyanidins on the secretion of interleukin-4 in peripheral blood mononuclear cells. J. Med. Food 3: 107-114.

    CAS  Article  Google Scholar 

  • Mao T, Powell J, Van DeWater J, Keen CL, Schmitz HH, Hammerstone JF & Gershwin ME (2000b) The effect of cocoa procyanidins on the transcription and secretion of interleukin 1 beta in peripheral blood mononuclear cells. Life Sci. 66: 1377-1386.

    PubMed  CAS  Article  Google Scholar 

  • Mao T, Van De Water J, Keen CL, Schmitz H & Gershwin M (2000c) Cocoa procyanidins and human cytokine transcription and secretion. J. Nutr. 130: 2093S-2099S.

    PubMed  CAS  Google Scholar 

  • Miura Y, Chiba T, Miura S, Tomita I, Umegaki K, Ikeda M & Tomita T (2000) Green tea polyphenols (flavan 3-ols) prevent oxidative modification of low density lipoproteins: An ex vivo study in humans. J. Nutr. Biochem. 11: 216-222.

    PubMed  CAS  Article  Google Scholar 

  • Olinski R, Gackowski D, Foksinski M, Rozalski R, Roszkowski K & Jaruga P (2002) Oxidative DNA damage: Assessment of the role in carcinogenesis, atherosclerosis, and acquired immunodeficiency syndrome. Free Radic. Biol. Med. 33: 192-200.

    PubMed  CAS  Article  Google Scholar 

  • Osakabe N, Baba S, Yasuda A, Iwamoto T, Kamiyama M, Takizawa T, Itakura H & Kondo K (2001) Daily cocoa intake reduces the susceptibility of low-density lipoprotein to oxdiation as demonstrated in healthy human volunteers. Free Rad. Res. 34: 93-99.

    CAS  Google Scholar 

  • Osakabe N, Sanbongi C, Yamagishi M, Takizawa T & Osawa T (1998) Effects of polyphenol substances derived from Theobroma cacao on gastric mucosal lesion induced by ethanol. Biosci. Biotechnol. Biochem. 62: 1535-1538.

    PubMed  CAS  Article  Google Scholar 

  • Ottavani JI, Carrasquedo F, Keen CL, Lazarus S, Schmitz HH & Fraga CG (2002) Influence of flavan-3-ols and procyanidins on UVC mediated formation of 8-oxo-7,8-dihydro-2'-deoxyguanosine in isolated DNA. Arch. Biochem. Biophys. 406: 203-208.

    Article  CAS  Google Scholar 

  • Pearson D, Paglieroni T, Rein D, Wun T, Schramm DD, Wang JF, Holt RR, Gosselin R, Schmitz HH & Keen CL (2002) The effects of flavanol-rich cocoa and aspirin on ex vivo platelet function. Thromb. Res. 106: 191-197.

    PubMed  CAS  Article  Google Scholar 

  • Pearson DA, Schmitz HH, Lazarus SA & Keen CL (2001) Inhibition of in vitro low-density lipoprotein oxidation by oligomeric procyanidins present in chocolate and cocoas. In: Packer L (ed) Methods in Enzymology. Vol 335: Flavonoids and Other Polyphenols. (pp. 350-360). Academic Press, New York.

    Google Scholar 

  • Pietta P-G (2000) Flavonoids as antioxidants. J. Nat. Prod. 63: 1035-1042.

    PubMed  CAS  Article  Google Scholar 

  • Pignatelli PP, Fabio M, Celestini A, Lenti L, Chiselli A, Gazzsaniga PP & Violi F (2000) The flavonoids quercetin and catechin synergistically inhibit platelet function by antagonizing the intracellular production of hydrogen peroxide. Am. J. Clin. Nutr. 72: 1150-1155.

    PubMed  CAS  Google Scholar 

  • Piskula MK & Terao J (1998) Accumulation of (-)-epicatechin metabolites in rat plasma after oral administration and distribution of conjugation enzymes in rat tissues. J. Nutr. 128: 1172-1178.

    PubMed  CAS  Google Scholar 

  • Podrez EA, Abu-Soud HM & Hazen SL (2000) Myeloperoxidase-generated oxidants and atherosclerosis. Free Radic. Biol. Med. 28: 1717-1725.

    PubMed  CAS  Article  Google Scholar 

  • Porter LJ, Ma Z & Chan B (1991) Cacao procyanidins: Major flavanoids and identification of some minor metabolites. Phytochemistry 30: 1657-1663.

    CAS  Article  Google Scholar 

  • Puppo A & Halliwell B (1988) Formation of hydroxyl radicals from hydrogen peroxide in the presence of iron. Biochem. J. 249: 185-190.

    PubMed  CAS  Google Scholar 

  • Rauch U, Osende JI, Fuster V, Badimon JJ, Fayad Z & Chesebro JH (2001) Thrombus formation on atherosclerotic plaques: pathogenesis and clinical consequences. Ann. Intern. Med. 134: 224-238.

    PubMed  CAS  Google Scholar 

  • Rechner AR, Kuhnle G, Bremner P, Hubbard GP, Moore KP & Rice-Evans C (2002) The metabolic fate of dietary polyphenols in humans. Free Radic. Biol.Med. 33: 220-235.

    PubMed  CAS  Article  Google Scholar 

  • Rein D, Lotito S, Holt RR, Keen CL, Schmitz HH & Fraga CG (2000a) Epicatechin in human plasma: in vivo determination and effect of chocolate consumption on plasma oxidation status. J. Nutr. 130: 2109S-2114S.

    PubMed  CAS  Google Scholar 

  • Rein D, Paglieroni TG, Wun T, Pearson DA, Schmitz HH, Gosselin R & Keen CL (2000b) Cocoa inhibits platelet activation and function. Am. J. Clin. Nutr. 72: 30-35.

    PubMed  CAS  Google Scholar 

  • Rice-Evans C (2001) Flavonoid antioxidants. Curr. Med. Chem. 8: 797-807.

    PubMed  CAS  Google Scholar 

  • Richelle M, Tavazzi I, Enslen M & Offord E (1999) Plasma kinetics in man of epicatechin from black chocolate. Eur. J. Clin. Nutr. 53: 22-26.

    PubMed  CAS  Article  Google Scholar 

  • Richelle M, Tavazzi I & Offord E (2001) Comparison of the antioxidant activity of commonly consumed polyphenolic beverages (coffee, cocoa, and tea) prepared per cup serving. J. Agric. Food Chem. 49: 3438-3442.

    PubMed  CAS  Article  Google Scholar 

  • Rios L, Bennett R, Lazarus S, Remesy C, Scalbert A & Williamson G (2002) Cocoa procyanidins are stable during gastric transit in humans. Am. J. Clin. Nutr. 76: 1106-1110.

    PubMed  CAS  Google Scholar 

  • Ross JA & Kasum CM (2002) Dietary flavonoids: Bioavailability, metabolic effects, and safety. Ann. Rev. Nutr. 22: 19-34.

    CAS  Article  Google Scholar 

  • Ross R (1999) Atherosclerosis-an inflammatory disease. N. Engl. J. Med. 340: 115-126.

    PubMed  CAS  Article  Google Scholar 

  • Salucci M, Stivala LA, Maiani G, Bugianesi R & Vannini V (2002) Flavonoids uptake and their effect on cell cycle of human colon adenocarcinoma cells (Caco2). Br. J. Cancer 86: 1645-1651.

    PubMed  CAS  Article  Google Scholar 

  • Sanbongi C, Osakabe N, Nausume M, Takizawa T, Gomi S & Osawa T (1998) Antioxidative polyphenols isolated from theobroma cacao. J. Agric. Food Chem. 46: 454-457.

    PubMed  CAS  Article  Google Scholar 

  • Sanbongi C, Suzuki N & Sakane T (1997) Polyphenols in chocolate, which have antioxidant activity, modulate immune functions in humans in vitro. Cell Immunolog. 177: 129-136.

    CAS  Article  Google Scholar 

  • Satoh K, Sakamoto Y, Ogata A, Nagai F, Mikuriya H, Numazawa M, Yamada K & Aoki N (2002) Inhibition of aromatase activity by green tea extract catechins and their endocrinological effects of oral administration in rats. Food Chem. Toxicol. 40: 925-933.

    PubMed  CAS  Article  Google Scholar 

  • Schewe T, Kuhn H & Sies H (2002) Flavonoids of cocoa inhibit recombinant human 5-lipoxygenase. J. Nutr. 132: 1825-1829.

    PubMed  CAS  Google Scholar 

  • Schewe T, Sadik C, Klotz L-O, Yoshimoto T, Kuhn H & Sies H (2001) Polyphenols of cocoa: Inhibition of mammalian 15-lipoxygenase. Biol. Chem. 382: 1687-1696.

    PubMed  CAS  Article  Google Scholar 

  • Schramm DD, Wang JF, Holt RR, Ensunsa JL, Gonsalves JL, Lazarus SL, Schmitz HH, German JB & Keen CL (2001) Chocolate procyanidins decrease the leukotriene-prostacyclin ratio in humans and human aortic endothelial cells. Am. J. Clin. Nutr. 73: 36-40.

    PubMed  CAS  Google Scholar 

  • ShinWS, Szuba A & Rockson SG (2002) The role of chemokines in human cardiovascular pathology: Enhanced biological insights. Atherosclerosis 160: 91-102.

    PubMed  CAS  Article  Google Scholar 

  • Spencer JP, Chaudry F, Pannala AS, Srai SK, Debnam E & Rice-Evans C (2000) Decomposition of cocoa procyanidins in the gastric milieu. Biochem. Biophys. Res. Commun. 272: 236-241.

    PubMed  CAS  Article  Google Scholar 

  • Spencer JP, Schroeter H, Shenoy B, Srai SK, Debnam E & Rice-Evans C (2001) Epicatechin is the primary bioavailable form of the procyanidin dimers B2 and B5 after transfer across the small intestine. Biochem. Biophys. Res. Commun. 285: 588-593.

    PubMed  CAS  Article  Google Scholar 

  • Steinberg FM, Holt RR, Schmitz HH & Keen CL (2002) Cocoa procyanidin chain length does not determine ability to protect LDL from oxidation when monomer units are controlled. J. Nutr. Biochem. (in press).

  • Stevens JF, Miranda CL, Wolthers KR, Schimerlik M, Deinzer ML & Buhler DR (2002) Identification and in vitro biological activities of hop proanthocyanidins: Inhibition of nNOS activity and scavenging of reactive nitrogen species. J. Agric. Food Chem. 50: 3435-3443.

    PubMed  CAS  Article  Google Scholar 

  • Tang FY & Meydani M (2001) Green tea catechins and vitamin E inhibit angiogenesis of human microvascular endothelial cells through suppression of IL-8 production. Nutr. Cancer 41: 119-125.

    PubMed  CAS  Article  Google Scholar 

  • Tribble DL (1999) Antioxidant consumption and risk of coronary heart disease: Emphasis on vitamin C, vitamin E, and B-carotene. A statement for healthcare professionals from the American Heart Association. Circulation 99: 591-595.

    PubMed  CAS  Google Scholar 

  • Vanhoutte P-M, Boulanger C-M & Mombouli J-V (1995) Endothelium-derived relaxing factors and converting enzyme inhibition. Am. J. Cardio. 76: 3E-12E.

    CAS  Article  Google Scholar 

  • Wan Y, Vinson JA, Etherton TD, Proch J, Lazarus S & Kris-Etherton P (2001) Effects of cocoa powder and dark chocolate on LDL oxidative susceptibility and prostaglandin concentrations in humans. Am. J. Clin. Nutr. 74: 596-602.

    PubMed  CAS  Google Scholar 

  • Wang JF, Schramm DD, Holt RR, Ensunsa JL, Fraga CG, Schmitz HH & Keen CL (2000) A dose-response effect from chocolate consumption on plasma epicatechin and oxidative damage. J. Nutr. 130: 2115S-2119S.

    PubMed  CAS  Google Scholar 

  • Warden BA, Smith LS, Beecher GR, Balentine D & Clevidence BA (2001) Catechins are bioavailable in men and women drinking black tea throughout the day. J. Nutr. 131: 1731-1737.

    PubMed  CAS  Google Scholar 

  • Waterhouse AL, Shirley JR & Donovan JL (1996) Antioxidants in chocolate. Lancet 348: 834.

    PubMed  CAS  Article  Google Scholar 

  • Youdim KA, McDonald J, Kalt W & Joseph JA (2002) Potential role of dietary flavonoids in reducing microvascular endothelium vulnerability to oxidative and inflammatory insults. J. Nutr. Biochem. 13: 282-288.

    PubMed  CAS  Article  Google Scholar 

  • Zhu Q, Holt R, Lazarus S, Ensunsa J, Hammerstone J, Schmitz H & Keen C (2002a) Stability of the flavan-3-ols epicatechin and catechin and related dimeric procyanidins derived from cocoa. J. Agric. Food Chem. 50: 1700-1705.

    PubMed  CAS  Article  Google Scholar 

  • Zhu Q, Holt R, Lazarus S, Orozco T & Keen C (2002b) Inhibitory effects of cocoa flavanols and procyanidin oligomers on free radical-induced erythrocyte hemolysis. Exp. Biol. Med. 227: 321-329.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Nutrition, USA

    Carl L. Keen

  2. Internal Medicine, University of California, Davis, One Shields Avenue, Davis, California, 95616, USA

    Carl L. Keen

  3. Analytical and Applied Sciences, Mars Incorporated, 800 High Street, Hackettstown, New Jersey, USA

    Harold H. Schmitz

  4. Departments of Nutrition, University of California, Davis, One Shields Avenue, Davis, California, 95616, USA

    Roberta R. Holt, John A. Polagruto & Janice F. Wang

Authors
  1. Carl L. Keen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberta R. Holt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John A. Polagruto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Janice F. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Harold H. Schmitz
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Keen, C.L., Holt, R.R., Polagruto, J.A. et al. Cocoa flavanols and cardiovascular health. Phytochemistry Reviews 1, 231–240 (2002). https://doi.org/10.1023/A:1022519719938

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1022519719938

  • antioxidants
  • cardiovascular health
  • chocolate
  • cocoa
  • flavanols
  • platelet
  • procyandins