Reference
Mostofsky E, Levitan EB, Wolk A, Mittleman MA. Chocolate intake and incidence of heart failure: a population-based prospective study of middle-aged and elderly women. Circ Heart Fail. 2010;3(5):612-616.
Design
Prospective cohort study
Participants
31,823 women aged 48 to 83 years who were participants in the Swedish Mammography Cohort
Study "Medication"
Chocolate. Frequency of chocolate consumption was contrasted with incidence of heart failure. The women were followed from January 1, 1998, through December 31, 2006, for heart failure (HF) hospitalization or death. During this period, 419 women were hospitalized for incident HF (n=379) or died of HF (n=40).
Key Findings
Women consuming 1 to 3 servings of chocolate per month compared with no regular chocolate intake, had a 26% lower risk of heart failure. Those consuming 1 to 2 servings per week had a 32% decrease in risk. At higher levels of consumption, risk may increase, but the numbers did not reach statistical significance.1
Practice Implications
Moderate consumption of chocolate (1–2 servings/week) might lower risk of heart failure in women, a finding that few will complain about.
Moderate consumption of chocolate (1 to 2 servings/week) might lower risk of heart failure in women, a finding that few will complain about.
A number of recent clinical trials utilizing high-polyphenol chocolate suggest that chocolate exerts a blood pressure–lowering effect in hypertensive individuals. A meta-analysis published in June 2010 combined data from 13 studies and concluded that “dark chocolate is superior to placebo in reducing systolic hypertension or diastolic prehypertension.”2
What is striking about the Mostofsky study is that no “special” chocolate was required. Plain chocolate, or at least the chocolate commonly consumed in Sweden, was adequate to produce significant benefit. This is not to say that the special high-polyphenol chocolates may not produce even greater benefit.
While on this topic, mention must be made of the 2009 study by Janszky et al. In this earlier paper, 1,169 Swedish patients were followed after they had been hospitalized with a first heart attack. Chocolate consumption along with hospitalizations and mortality were tracked. Chocolate consumption had a strong inverse association with cardiac mortality. When compared with those of people who never eat chocolate, the hazard ratios were 0.73 for those consuming chocolate less than once per month, 0.56 up to once per week, and 0.34 for twice or more per week. In contrast, intake of other sweets was not associated with cardiac or total mortality.3
Thus the data now clearly support our telling patients that weekly consumption of chocolate is not only acceptable but actually recommended for those at elevated risk for heart failure or myocardial infarction.
