http://www.medscape.com/viewarticle/846595?nlid=82923_2863&src=wnl_edit_dail#vp_1
Higher Chocolate Intake May Lower Risk for CV Disease, Stroke in Healthy
Adults

Deborah Brauser

June 16, 2015


NEW YORK, NY — Rejoice, chocolate lovers: more findings suggest that
regular consumption of the sweet stuff may decrease the risk of CV events
and stroke in otherwise-healthy individuals[1].

Analysis of almost 21,000 adults from the UK's EPIC-Norfolk study
<http://www.srl.cam.ac.uk/epic/> showed that those who ate the most
chocolate had an 11% lower risk of developing coronary heart disease (CHD)
and a 25% lower risk of CV-related death over 12 years of follow-up when
compared with those who ate no chocolate. In addition, the
highest-consumption group had a 23% lower risk of stroke.

A separate meta-analysis of more than 155,000 participants in studies
examining possible links between chocolate and CV outcomes showed similar
findings.

The authors, led by Dr Chun Shing Kwok (University of Aberdeen, Scotland),
note that although cause and effect could not be shown in these
observational studies, cumulative evidence suggests that there is an
association at play.

Interestingly, the participants in the cohort study ate more milk chocolate
than dark chocolate, which may indicate that "not only flavonoids, but also
other compounds, possibly related to milk constituents such as calcium and
fatty acids, may provide an explanation for the observed association,"
write the investigators.

The findings were published online June 15, 2015 in *Heart. *

*More Chocolate, Less Risk*

For the current analysis, the researchers examined records from 20,951
EPIC-Norfolk participants who filled out the food frequency questionnaire
at baseline, which included questions about chocolate consumption. The
participants were then divided into five "quintiles" based on their
chocolate habits, with the highest group consuming 16 to 99 g/day of
chocolate.

After a median of 11.9 years of follow-up, there were 2434 CHD events. Of
these events, 13.8% occurred among those who ate the least amount of
chocolate and 9.7% occurred among those in the highest quintile of
chocolate consumption. There were also 848 strokes overall, including 5.4%
and 3.1% of the lowest and highest quintiles, respectively.

Compared with those who didn't eat any chocolate, the adjusted hazard ratio
(HR) for the highest-consumption group was 0.89 (95% CI 0.79–1.00, *P*=0.02)
for total CVD and 0.75 for CVD mortality (95% CI 0.62–0.92, *P*=0.01). This
group also had significantly lower risk of CHD-related hospitalization or
mortality in minimally adjusted models, but not in the fully adjusted
models.

However, the highest-consumption group did have a significantly lower risk
of stroke in both types of models (both HR 0.77, *P*<0.05).

In the systematic review of nine studies and 157,809 participants, the
highest quintile of chocolate eaters vs the lowest quintile had
significantly lower risk of CHD, stroke, composite CV adverse outcomes, and
CV mortality—with pooled risk ratios (RRs) of 0.71, 0.79, 0.75, and 0.55,
respectively.

Interestingly, the non–chocolate-eating group had the highest mean
body-mass index, the highest percentage of participants with diabetes, and
the highest levels of inactivity. On the other hand, "higher chocolate
intake was associated with a higher energy intake, with lower contributions
from protein and alcohol sources and higher contributions from fat and
carbohydrates," write the investigators.

Overall, they reiterate that their analyses do not show causation. However,
"within the general context of existing recommendations for behaviors
conductive to cardiovascular health, there does not appear to be evidence
that chocolate should be avoided."

*EPIC-Norfolk was funded by grants from the Medical Research Council and
Cancer Research UK. Kwok and the coauthors report they have no relevant
financial relationships. *


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