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Cocoa Consumption, Cocoa Flavonoids, and Effects on Cardiovascular Risk Factors: An Evidence-Based Review

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Abstract

There has been considerable interest in the health effects of cocoa products. Cocoa flavonoids have especially been associated with cardiovascular disease (CVD) risk factors. We summarize the effects of total flavonoid and cocoa flavonoid consumption on CVD endpoints in observational studies and intermediate risk factors in experimental designs. From an evidence-based review, there is strong evidence that high cocoa intake lowers blood pressure, improves vascular endothelial function, and potentially increases insulin sensitivity. However, evidence does not support effects on blood lipids and body weight. Total flavonoid intake, and potentially cocoa flavonoid intake, is associated with coronary heart disease mortality in observational studies; however, there is conflicting evidence regarding the dose at which cocoa flavonoids are beneficial. Moreover, because chocolate is often nutritionally energy dense and with added sugar, considerations must be given to caloric balance and body weight. Overall, combining the multiple lines of evidence from experimental and observational studies on the effects of cocoa flavonoids and cocoa intake on cardiovascular risk factors, there is rather strong evidence supporting and demonstrating that cocoa consumption improves several important cardiovascular risk factors and likely reduces the risk of CVD, although more research is needed to further examine etiological mechanisms, demonstrate efficacy on hard clinical CVD endpoints in large-scale randomized trials, as well as carefully estimate attributable disease burden. More importantly, as intake of cocoa is inextricably linked with increased calories in chocolate consumption, further careful risk-benefit analysis is needed to assess whether consuming cocoa in the form of energy-dense chocolate products may yield a net benefit on cardiovascular risks.

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Disclosure

Scott R. Bauer reports no potential conflict of interest relevant to this article. Eric L. Ding reports no potential conflict of interest relevant to this article. Liesbeth A. Smit reports no potential conflict of interest relevant to this article.

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Authors and Affiliations

  1. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Scott R. Bauer

  2. Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Scott R. Bauer & Eric L. Ding

  3. Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

    Eric L. Ding

  4. Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands

    Liesbeth A. Smit

  5. 655 Huntington Ave, Building 2, 3rd Floor Nutrition, Boston, MA, 02115, USA

    Eric L. Ding

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  1. Scott R. Bauer
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Correspondence to Eric L. Ding.

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Scott R. Bauer and Eric L. Ding contributed equally to the manuscript.

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Bauer, S.R., Ding, E.L. & Smit, L.A. Cocoa Consumption, Cocoa Flavonoids, and Effects on Cardiovascular Risk Factors: An Evidence-Based Review. Curr Cardiovasc Risk Rep 5, 120–127 (2011). https://doi.org/10.1007/s12170-011-0157-5

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