Chocolate Flavonoids in the Prevention of Arterial Disease

  • Nancy J. Correa-MatosEmail author
  • Catherine Christie
Part of the Nutrition and Health book series (NH, volume 7)

Key Points

  • Chocolate, which provides a concentrated source of energy because of its high-fat content, belongs to a class of polyphenols known as flavonoids, which contain such celebrated foods as red grapes, tea, soy, and garlic.

  • Dark chocolate contains the highest amount of flavonoid-rich cocoa.

  • Both short- and long-term ingestion of chocolate products result in an increase in serum antioxidant capacity and a decrease in LDL oxidation, both linked to reduced heart disease risk.

  • Health benefits from chocolate consumption related to cardiovascular disease include the health neutrality of its saturated fatty acid (stearic acid) and protective effects of its flavonols, including flavanols and procyanidins.

  • Health benefits from chocolate consumption related to cardiovascular disease prevention include anti-inflammatory functions, which prevent development of fatty streaks in the beginning stages of the atherosclerotic process.


Chocolate flavonoids Heart disease prevention Increased antioxidant capacity Decreased LDL oxidation Increased chocolate consumption worldwide 


  1. 1.
    World Health Organization. The Atlas of heart disease and stroke. Available at: Accessed 1 Mar 2006.
  2. 2.
    Eyre H, Kahn R, Robertson RM. Preventing, cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Diabetes Care. 2004;27:1812–24.PubMedCrossRefGoogle Scholar
  3. 3.
    Borchers AT, Keen CL, Hannum SM, Gershwin ME. Cocoa and chocolate: composition, bioavailability, and health implications. J Med Food. 2000;3(2):77–104.CrossRefGoogle Scholar
  4. 4.
    Steinberg FM, Bearden MM, Keen CL. Cocoa and chocolate flavonoids: implications for cardiovascular health. J Am Diet Assoc. 2003;103:215–23.PubMedCrossRefGoogle Scholar
  5. 5.
    Chocolate Manufacturers Association. The story of chocolate. Available at: Accessed 23 Feb 2006.
  6. 6.
    Dillinger TL, Barriga P, Escarcega S, Jimenez M, Lowe DS, Grivetti LE. Food for the Gods: cure for humanity? A cultural history of the medicinal and ritual uses of chocolate. J Nutr. 2000;30:2057S–72.Google Scholar
  7. 7.
    Morton M, Morton F. Chocolate: an illustrated history. New York: Crown Publishers; 1986.Google Scholar
  8. 8.
    Telly C. Chocolate: its quality and flavor (which is the world’s best chocolate). In: Szogyi A, editors. Chocolate: food of the gods. Westport: Greenwood Press; 1997:165–166; USDA (2005) National Nutrient Database for Standard Reference, Release 18. Available at: Accessed 23 Jan 2006.
  9. 9.
    Corti R, Flammer AJ, Hollenberg NK, Lüscher TF. Cocoa and cardiovascular health. Circulation. 2009;119(10):1433–41.PubMedCrossRefGoogle Scholar
  10. 10.
    Kris-Etherton PM, Derr JA, Mitchell DC. The role of fatty acid saturation on plasma lipids, lipoproteins and apoliproteins: effects of whole food diets high in cocoa butter, olive oil, soybean oil, dairy butter and milk chocolate on the plasma lipids of young men. Metabolism. 1993;42:130–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Kris-Etherton PM, Derr JA, Mustad VA, Seligson FH, Pearson TA. Effects of a milk chocolate bar a day substituted for a high carbohydrate snack increases high-density lipoprotein cholesterol in young men on a NCEP/AHA step one diet. Am J Clin Nutr. 1994;60:1037S–42.PubMedGoogle Scholar
  12. 12.
    Jones AE, Stolinski M, Smith RD, Murphy JL, Wootten SA. Effects of fatty acid chain length and saturation on the gastrointestinal handling and metabolic disposal of dietary fatty acids in women. Br J Nutr. 1999;81:37–43.PubMedCrossRefGoogle Scholar
  13. 13.
    Baer DJ, Judd JT, Kris-Etherton PM, Zhao G, Emken EA. Stearic acid absorption and its metabolizable energy value are minimally lower than those of other fatty acids in healthy men fed mixed diets. J Nutr. 2003;133:4129–34.PubMedGoogle Scholar
  14. 14.
    Nestel PJ, Pomeroy S, Kay S, Sasahara T, Yamashita T. Effect of a stearic acid-rich structured triacylglycerol on plasma lipid concentrations. Am J Clin Nutr. 1998;68:1196–201.PubMedGoogle Scholar
  15. 15.
    Brink EJ, Haddeman E, de Fouw NJ, Westrate JA. Positional distribution of stearic acid-rich, structured triacylglycerol and dietary calcium concentration determines the apparent absorption of these fatty acids in rats. J Nutr. 1995; 125:2379–2387.Google Scholar
  16. 16.
    Mursu J, Voutilainen S, Nurmi T, Rissanen TH, Virtanen JK, Kaikkonen J, 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(9):1351–9.PubMedCrossRefGoogle Scholar
  17. 17.
    USDA. 2005. National nutrient database for standard reference, Release 18. Available at: Accessed 23 Jan 2006.
  18. 18.
    Executive Summary of the 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). JAMA. 2001; 285:2486–2498.Google Scholar
  19. 19.
    King DE, Mainous 3rd AG, Geesey ME, Woolson RF. Dietary magnesium and C-reactive protein levels. J Am Coll Nutr. 2005;24(3):166–71.PubMedGoogle Scholar
  20. 20.
    Barbagallo M, Dominguez LJ, Galioto A, Ferlisi A, Cani C, Malfa L, et al. Role of magnesium in insulin action, diabetes and cardio-metabolic syndrome X. Mol Aspects Med. 2003;24(1–3):39–52.PubMedCrossRefGoogle Scholar
  21. 21.
    Hammerstone JF, Lazarus SA, Schmitz HH. Procyanidin content and variation in some commonly consumed foods. J Nutr. 2000;130:2086S–91.PubMedGoogle Scholar
  22. 22.
    Prior RL, Lazarus SA, Cao G, Muccitelli H, Hammerstone JF. Identification of procyanidins and anthocyanins in blueberries and cranberries (Vaccinium sp) using high-performance liquid chromatography/mass spectrometry. J Agric Food Chem. 2001;49:1270–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Adamson GE, Lazarus SA, Mitchell AE, Prior RL, Cao G, Jacobs PH, et al. HPLC method for the quantification of procyanidins in cocoa and chocolate samples and correlation to total antioxidant capacity. J Agric Food Chem. 1999;47:4184–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Hammerstone JF, Lazarus SA, Mitchell AE, Rucker R, Schmidt HH. Identification of procyanidins in cocoa (Thembroma cacao) and chocolate using high-performance liquid chromatography/mass spectrometry. J Agric Food Chem. 1999;47:490–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Spencer JPE, Chaudry F, Pannala AS, Srai SK, Debnam E, Rice-Evans C. Decomposition of cocoa procyanidins in the gastric milieu. Biochem Biophys Res Commun. 2000;272:236–41.PubMedCrossRefGoogle Scholar
  26. 26.
    Rios LY, Bennett RN, Lazarus SA, Remesy C, Scalbert A, Williamson G. Cocoa procyanidins are stable during gastric transit in humans. Am J Clin Nutr. 2002;76:1106–10.PubMedGoogle Scholar
  27. 27.
    Mullen W, Borges G, Donovan JL, et al. Milk decreases urinary excretion but not plasma pharmacokinetics of cocoa flavan-3-ol metabolites in humans. Am J Clin Nutr. 2009;89:1784–91.PubMedCrossRefGoogle Scholar
  28. 28.
    Spencer JP, Schroeter H, Shenoy B, Srai SKS, Debnam ES, Rice-Evans C. Epicatechin is the primary bioavailable form of the procyanidin dimers B2 and B5 after transfer across the small intestine. Biochem Biophys Res Commun. 2001;285:88–593.CrossRefGoogle Scholar
  29. 29.
    Holt RR, Lazarus SA, Sullards MC, Zhu QY, Schramm DD, Hammerstone JF, et al. Procyanidin dimer B2 [epicatechin-(4 β)-epicatechin] in human plasma after the consumption of a flavanol-rich cocoa. Am J Clin Nutr. 2002;76:798–804.PubMedGoogle Scholar
  30. 30.
    Rios LY, Gonthier MP, Remesy C, Mila I, Lapierre C, Lazarus SA, et al. Chocolate intake increases urinary excretion of polyphenol-derived phenolic acids in healthy human subjects. Am J Clin Nutr. 2003;77:912–8.PubMedGoogle Scholar
  31. 31.
    Keen CL, Holt RR, Oteiza PI, Fraga CG, Schmitz HH. Cocoa antioxidants and cardiovascular health. Am J Clin Nutr. 2005;81(1):298s–303.PubMedGoogle Scholar
  32. 32.
    Ding EL, Hutfless SM, Ding X, Girotra S. Chocolate and prevention of cardiovascular disease: a systematic review. Nutr Metab (Lond). 2006; 3:2. (BioMed Central ISSN 1743–7075).Google Scholar
  33. 33.
    Galleano M, Oteiza PI, Fraga CG. Cocoa, chocolate, and cardiovascular disease. J Cardiovasc Pharmacol. 2009;54(6):483–90.PubMedCrossRefGoogle Scholar
  34. 34.
    Mathur S, Devaraj S, Grundy SM, Jialal I. Cocoa products decrease low density lipoprotein susceptibility but do not affect biomarkers of inflammation in humans. J Nutr. 2002;132:3663–7.PubMedGoogle Scholar
  35. 35.
    Wan Y, Vinson JA, Etherton TD, Proch J, Lazarus SA, Kris-Etherton PM. Effects of cocoa powder and dark chocolate on LDL oxidative susceptibility and prostaglandin concentrations in humans. Am J Clin Nutr. 2002;74:596–602.Google Scholar
  36. 36.
    Wang JF, Schramm DD, Holt RR, Ensunsa JL, et al. A dose–response effect from chocolate consumption on plasma epicatechin and oxidative damage. J Nutr. 2000;130(8s):2115s–9s.PubMedGoogle Scholar
  37. 37.
    Zhang WY, Liu HQ, Xie KQ, et al. Procyanidin dimer B2 [epicatechin-(4beta-8)-epicatechin] suppresses the expression of cyclooxygenase-2 in endotoxin-treated monocytic cells. Biochem Biophys Res Commun. 2006;345:508–15.PubMedCrossRefGoogle Scholar
  38. 38.
    Lee KW, Kundu JK, Kim SO, et al. Cocoa polyphenols inhibit phorbol ester-induced superoxide anion formation in cultured HL-60 cells and expression of cyclooxygenase-2 and activation of NF-kappaB and MAPKs in mouse skin in vivo. J Nutr. 2006;136:1150–5.PubMedGoogle Scholar
  39. 39.
    Rader DJ. Inhibition of cholesteryl ester transfer protein activity: a new therapeutic approach to raising high-density lipoprotein. Curr Atheroscler Rep. 2004;6(5):398–405.PubMedCrossRefGoogle Scholar
  40. 40.
    Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;106(18):135–6.CrossRefGoogle Scholar
  41. 41.
    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(11):1340–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Grosser T. The pharmacology of selective inhibition of COX-2. Thromb Haemost. 2006;96(4):393–400.PubMedGoogle Scholar
  43. 43.
    Bremner P, Heinrich M. Natural products as targeted modulators of the nuclear factor-kappaB pathway. J Pharm Pharmacol. 2002;54(4):453–72.PubMedCrossRefGoogle Scholar
  44. 44.
    Sharma R, Coats AJ, Anker SD. The role of inflammatory mediators in chronic heart failure: cytokines, nitric oxide, and endothelin-1. Int J Cardiol. 2000;72(2):175–86.PubMedCrossRefGoogle Scholar
  45. 45.
    Arteel GE, Sies H. Protection against peroxynitrite by cocoa polyphenol oligomers. FEBS Lett. 1999;462:167–70.PubMedCrossRefGoogle Scholar
  46. 46.
    Arteel GE, Schroeder P, Sies H. Reactions of peroxynitrite with cocoa procyanidin oligomers. J Nutr. 2000;130:2100S–4.PubMedGoogle Scholar
  47. 47.
    Sies H, Schewe T, Heiss C, Kelm M. Cocoa polyphenols and inflammatory mediators. Am J Clin Nutr. 2005;8:304S–12.Google Scholar
  48. 48.
    Mann GE, Rowlands DJ, Li FY, de Winter P, Siow RC. Activation of endothelial nitric oxide synthase by dietary isoflavones: role of NO in Nrf2-mediated antioxidant gene expression. Cardiovasc Res. 2007;75(2):261–74.PubMedCrossRefGoogle Scholar
  49. 49.
    Flammer AJ, Hermann F, Sudano I, et al. Dark chocolate improves coronary vasomotion and reduces platelet reactivity. Circulation. 2007;116:2376–82.PubMedCrossRefGoogle Scholar
  50. 50.
    Taubert D, Roesen R, Lehmann C, Jung N, Schömig E. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA. 2007;298(1):49–60.PubMedCrossRefGoogle Scholar
  51. 51.
    Simon JA, Fong J, Bernert Jr JT. Serum fatty acids and blood pressure. Hypertension. 1996;27:303–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Jenkins DJ, Kendall CW, Vuksan V, Vidgen E, Wong E, Augustin LS, et al. Effect of cocoa bran on low-density lipoprotein oxidation and fecal bulking. Arch Intern Med. 2000;160(15):2374–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Raederstorff DG, Schlachter MF, Elste V, Weber P. Effect of EGCG on lipid absorption and plasma lipid levels in rats. J Nutr Biochem. 2003;14(6):326–32.PubMedCrossRefGoogle Scholar
  54. 54.
    Rein D, Paglieroni TG, Pearson DA, Wun T, Schmitz HH, Gosselin R, et al. Cocoa and wine polyphenols modulate platelet activation and function. J Nutr. 2000;130:2120s–6.PubMedGoogle Scholar
  55. 55.
    Rein D, Paglieroni TG, Wun T, Pearson DA, Schmitz HH, Gosselin R, et al. Cocoa inhibits platelet activation and function. Am J Clin Nutr. 2000;72:30–5.PubMedGoogle Scholar
  56. 56.
    Innes AJ, Kennedy G, McLaren M, Bancroft AJ, Belch J. Dark chocolate inhibits platelet aggregation in healthy volunteers. Platelets. 2003;14(5):325–7.PubMedCrossRefGoogle Scholar
  57. 57.
    Schramm DD, Wang JF, Holt RR, Ensunsa JL, Gonsalves JL, Lazarus SA, et al. Chocolate procyanidins decrease the leuotriene-prostacyclin ratio in human and human aortic endothelial cells. Am J Clin Nutr. 2001;73:36–40.PubMedGoogle Scholar
  58. 58.
    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(3):611–4.PubMedGoogle Scholar
  59. 59.
    Baba S, Natsume M, Yasuda A, et al. Plasma LDL and HDL cholesterol and oxidized LDL concentrations are altered in normo- and hypercholesterolemic humans after intake of different levels of cocoa powder. J Nutr. 2007;137:1436–41.PubMedGoogle Scholar
  60. 60.
    Crews WD Jr, Harrison DW, Wright JW. A double-blind, placebo-controlled, randomized trial of the effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health: clinical findings from a sample of healthy, cognitively intact older adults. Am J Clin Nutr. 2008;87(4):872–80.PubMedGoogle Scholar
  61. 61.
    Hamed MS, Gambert S, Bliden KP, Bailon O, Singla A, Antonino MJ, Hamed F, Tantry US, Gurbel PA. Dark chocolate effect on platelet activity, C-reactive protein and lipid profile: a pilot study. South Med J. 2008;101(12):1203–8.PubMedGoogle Scholar
  62. 62.
    Heiss C, Kleinbongard P, Dejam A, Perré S, Schroeter H, Sies H, Kelm M. Acute consumption of flavanol-rich cocoa and the reversal of endothelial dysfunction in smokers. J Am Coll Cardiol. 2005;46(7):1276–83.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2013

Authors and Affiliations

  1. 1.Department of Nutrition and Dietetics, Brooks College of HealthUniversity of North FloridaJacksonvilleUSA
  2. 2.Brooks College of HealthUniversity of North FloridaJacksonvilleUSA

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