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Chocolate Lowers Heart Failure Risk by 26%

Posted: Tuesday, September 21, 2010

A chocolate habit may protect women from heart failure later in life -- but only when enjoyed in moderation, researchers found.

A prospective cohort study of almost 32,000 middle-age and older Swedish women found that one to three servings a month of European chocolate (typically higher in cocoa content) reduced the risk of heart failure 26% (95% CI 0.58 to 0.95) over nine years, according to Murray A. Mittleman, MD, DrPH, of Beth Israel Deaconess Medical Center in Boston, MA, and colleagues.

Women who ate European chocolate once or twice a week had a 32% lower heart failure risk (95% CI 0.50 to 0.93) compared with those who didn't regularly eat the candy. However, indulging too much appeared potentially harmful.

The adjusted rate ratio of heart failure among the study cohort was 1.09 for those who had three to six servings of chocolate per week (95% CI 0.74 to 1.62), compared with no consumption.

And the adjusted rate ratio of heart failure was 1.23 for at least daily consumption (95% CI 0.73 to 2.08) compared with no regular intake of chocolate.

Overall, though, this is good news for chocolate lovers -- matching the protective effects seen in other types of heart disease, commented Linda Van Horn, PhD, RD, of Northwestern University in Chicago and a spokesperson for the American Heart Association.

At higher levels of intake, though, the saturated fat intake may counterbalance heart-healthy effects and lead to weight gain, she cautioned. Also, the cocoa content and quality of European chocolate appears to differ from that of American products, Van Horn noted.

"Dark chocolate in the U.S. is not necessarily the same as chocolate in Europe," she said in an interview. "Therefore, one cannot assume the darkness of the chocolate is the potency of the isoflavone content."

Suzanne Steinbaum, DO, of Lenox Hill Hospital in New York City and also an AHA spokesperson, likewise cautioned women to continue to watch their calories when eating chocolate. She also recommended that patients look for higher cocoa content -- 70% or greater -- when choosing chocolate.

Long-term observational studies and short-term trials have found protective effects for dark chocolate in other types of cardiovascular disease, Mittleman and co-authors noted.

Cocoa flavonoids are associated with decreased susceptibility to oxidation of LDL cholesterol and improved endothelial function, they added.

Observational studies have shown chocolate is associated with reduced blood pressure, lower incidence of stroke and myocardial infarction (MI), lower incidence of deaths from coronary heart disease, and lower cardiac mortality in patients surviving their first MI, according to background information in the report.

"However, despite clinical trials showing the effect of chocolate on blood pressure and the strong relationship between blood pressure and heart failure, no prior studies have examined the association between chocolate intake and heart failure," the authors noted.

To examine that association, Mittleman's team conducted a cohort study among 31,823 women ages 48 to 83 without a baseline history of diabetes, heart failure, or heart attack, who had completed food-frequency questionnaires as part of the larger Swedish Mammography Cohort study. The researchers followed women over nine years for heart failure hospitalization and death using national healthcare databases.

Their chocolate intake findings suggested a J-shaped correlation with heart failure incidence such that the lowest and highest intakes were associated with higher risk (P=0.0005 for quadratic trend).

Practice Pearls:

    * The association didn't differ by intake of dairy, which has been shown to impair absorption of chocolate's flavonoids (P=0.34 for interaction). Nor did level of physical activity matter in the relationship between heart failure risk and chocolate intake (P=0.70 for interaction).
    * Explain to interested patients that eating chocolate may protect middle-age women from heart failure in their later years -- as long as they indulge in moderation.
    * Note that one to three servings a month of European chocolate (which usually contains more cocoa) reduced the risk of heart failure 26% over nine years in this study of 32,000 Swedish women.

Further note that at higher levels of chocolate consumption (one serving daily), the risk of heart failure actually increased by 23%, compared with no regular intake.

Source:, Mostofsky E, et al "Chocolate intake and incidence of heart failure: A population-based, prospective study of middle-aged and elderly women" Circ Heart Fail 2010; DOI:10.1161/CIRCHEARTFAILURE.110.944025.

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