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Chocolate Intake and Incidence of Heart Failure
A Population-Based Prospective Study of Middle-Aged and Elderly Women

This article is #1 of the 50 most frequently read articles published by the American Heart Association's "Circulation: Heart Failure" journal. Referenced researchers: E Mostofsky, MPH; EB Levitan, ScD; A Wolk, DrMedSci; MA Mittleman, MD, DrPH. Below is the abstract.

Background: Randomized clinical trials have shown that chocolate intake reduces systolic and diastolic blood pressure, and observational studies have found an inverse association between chocolate intake and cardiovascular disease. The aim of this study was to investigate the association between chocolate intake and incidence of heart failure (HF).

Methods and Results: We conducted a prospective cohort study of 31,823 women aged 48 to 83 years without baseline diabetes or a history of HF or myocardial infarction who were participants in the Swedish Mammography Cohort. In addiiton to answering health and lifestyle questions, participants completed a food-frequency questionaire. Women were followed from January 1, 1998 through December 31, 2006, for HF hospitalization or death through the Swedish inpatient and cause-of-death registers. Over 9 years of follow-up, 419 women were hospitalized for incident HF (379) or died of HF (40). Compared with no regular chocolate intake, the multivariable-adjusted rate ratio of HF was 0.74 (95% CI, 0.58 to 0.95) for women consuming 1 to 3 servings of chocolate per month, 0.68 (95% CI, 0.50 to 0.93) for those consuming 1 to 2 servings per week, 1.09 (95% CI, 0.74 to 1.62) for those consuming 3 to 6 servings per week, and 1.23 (95% CI, 0.73 to 2.08) for those consuming one or more servings per day (P=0.0005 for quadratic trend).

Conclusions: In this population, moderate habitual chocolate intake was associated with a lower rate of HF hospitalization or death, but the protective association was not observed with intake of one or more servings per day.

The above abstract was published in the Circulation: Heart Failure journal. The full text was published in September, 2010. Click here to see the full article..

The study was conducted by researchers from Harvard University and Sweden's Institute of Environmental Medicine. The study followed the women for nine years and found that women who ate about 2/3 of an ounce to an ounce of high-quality chocolate once or twice a week had a 32% lower risk of developing heart failure. The women who ate that amount one to three times a month (less often) had a 26% lower risk, and those who ate that amount (or more) daily did not show any benefit, which is presumed to be related to extra calories leading to weight gain or a less nutritious diet, offsetting the benefits of the chocolate. The study noted that small amounts of dark chocolate in a person's diet could help lower blood pressure and that some studies indicate the flavonoids in chocolate help improve blood vessel health.

What is high-quality chocolate?

This is a decision of the manufacturer. Cocoa beans are harvested and then processed into (1) cocoa solids and (2) cocoa butter. The solids contain nutrients that may help prevent heart failure. Check the ingredients before you buy chocolate to see how high the percentage of cocoa content is. As the percentage increases, that chocolate's antioxidant content increases. The higher the percentage of cocoa solids, the darker and more pure it is. It also will taste more bitter, as fewer sweeteners have been added. That is dark chocolate, which was the original historic product. A good example is unsweetened baking chocolate. As manufacturers worked to increase chocolate sales, other ingredients were added, increasing fat content and calories, but lowing antioxidant count. For example, milk chocolate includes milk powder or condensed milk, which studies have shown may interfere with absorption of antioxidants. The least beneficial chocolate is white chocolate, made from cocoa butter, sugar and milk. White chocolate has no cocoa solids, and, consequently, no antioxidants.

There are six benefits of high quality (dark and pure) chocolate:
 1) dilation of blood vessels lowers blood pressure,
 2) reduction of blood sugar and insulin reduces risk of diabetes,
 3) reduction of free-radicals, reducing carcinogens and mutagens,
 4) reducing risk of strokes and heart attacks by inhibiting platelet clumping,
 5) promote stability of blood cholesterol levels, and
 6) improving circulation, increasing body health and cognitive function.

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