Chocolate Consumption and Cardiovascular Disease Risk

* In this systematic review and meta-analysis, 23 studies including 405,304 participants and 35,093 cases of cardiovascular disease were included to determine the risk of cardiovascular disease with chocolate consumption. For each 20-g/week increase in chocolate consumption, the relative risk was 0.982 for cardiovascular disease. Based on a nonlinear dose–response relationship, consumption of 45 g/week was the most appropriate dose of chocolate for reducing cardiovascular disease risk.
* These results suggest that consuming <100 g of chocolate per week may be associated with reduced cardiovascular disease risk.
It’s nice to know that some things can taste good and also be good for you, such as wine, coffee, Mediterranean diet, and, as this meta-analysis shows, chocolate. Because of inconsistent outcomes for the latter, the present authors asked whether there might be a dose–response association between chocolate consumption and incident cardiovascular disease, including stroke, myocardial infarction, and heart failure. They analyzed 14 publications (including 23 cohort studies) reporting on different outcomes in the meta-analysis. The authors found evidence of a nonlinear association between chocolate intake and cardiovascular disease and Heart Failure, with the strongest reduction in risk observed at ~45 g/week (a chocolate single or square per day or a chocolate snack bar per week) and ~60 to 75 g/week, respectively. The protective effect for cardiovascular disease is lost when chocolate intake exceeds 100 g/week (two chocolate snack bars per week) perhaps due to the negative effects of high calorie and/or fat intake associated with higher chocolate consumption, which may counterbalance any health benefits due to weight gain and associated health problems. These data must be interpreted cautiously because chocolate consumption was self-reported, the type of chocolate not identified, and the study is a meta-analysis from which definitive conclusions cannot be established. Nevertheless, the results will appease my conscience as I let that chocolate melt in my mouth!
Studies investigating the impact of chocolate consumption on cardiovascular disease (CVD) have reached inconsistent conclusions. As such, a quantitative assessment of the dose-response association between chocolate consumption and incident cardiovascular disease has not been reported. We performed a systematic review and meta-analysis of studies assessing the risk of cardiovascular disease with chocolate consumption.
PubMed and EMBASE databases were searched for articles published up to 6 June 2018. Restricted cubic splines were used to model the dose-response association.
Fourteen publications (23 studies including 405 304 participants and 35 093 cases of cardiovascular disease) were included in the meta-analysis. The summary of relative risk (RR) per 20 g/week increase in chocolate consumption was 0.982 (95% CI 0.972 to 0.992, I2=50.4%, n=18) for cardiovascular disease (heart failure: 0.995 (0.981 to 1.010, I2=36.3%, n=5); total stroke: 0.956 (0.932 to 0.980, I2=25.5%, n=7); cerebral infarction: 0.952 (0.917 to 0.988, I2=0.0%, n=4); haemorrhagic stroke: 0.931 (0.871 to 0.994, I2=0.0%, n=4); myocardial infarction: 0.981 (0.964 to 0.997, I2=0.0%, n=3); coronary heart disease: 0.986 (0.973 to 0.999, n=1)). A non-linear dose-response (pnon-linearity=0.001) indicated that the most appropriate dose of chocolate consumption for reducing risk of cardiovascular disease was 45 g/week (RR 0.890;95%CI 0.849 to 0.932).
Chocolate consumption may be associated with reduced risk of cardiovascular disease at <100 g/week consumption. Higher levels may negate the health benefits and induce adverse effects associated with high sugar consumption.
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* Article Citation
Heart (British Cardiac Society)
Chocolate Consumption and Risk of Cardiovascular Diseases: A Meta-Analysis of Prospective Studies
Heart 2018 Jul 30;[EPub Ahead of Print], Y Ren, Y Liu, XZ Sun, BY Wang, Y Zhao, DC Liu, DD Zhang, XJ Liu, RY Zhang, HH Sun, FY Liu, X Chen, C Cheng, LL Liu, QG Zhou, M Zhang, DS Hu
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Take home message written by Douglas P Zipes MD
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