Chocolate intake and incidence of heart failure: Findings from the Cohort of Swedish Men

doi:10.1016/j.ahj.2016.10.002

American Heart Journal

Volume 183, January 2017, Pages 18-23

https://doi.org/10.1016/j.ahj.2016.10.002 Get rights and content

Aims

The objective of this study was to evaluate the association of chocolate consumption and heart failure (HF) in a large population of Swedish men.

Methods

We conducted a prospective cohort study of 31,917 men 45-79 years old with no history of myocardial infarction, diabetes, or HF at baseline who were participants in the population-based Cohort of Swedish Men study. Chocolate consumption was assessed through a self-administrated food frequency questionnaire. Participants were followed for HF hospitalization or mortality from January 1, 1998, to December 31, 2011, using record linkage to the Swedish inpatient and cause-of-death registries.

Results

During 14 years of follow-up, 2,157 men were hospitalized (n = 1,901) or died from incident HF (n = 256). Compared with subjects who reported no chocolate intake, the multivariable-adjusted rate ratio of HF was 0.88 (95% CI 0.78-0.99) for those consuming 1-3 servings per month, 0.83 (95% CI 0.72-0.94) for those consuming 1-2 servings per week, 0.82 (95% CI 0.68-0.99) for those consuming 3-6 servings per week, and 1.10 (95% CI 0.84-1.45) for those consuming ≥1 serving per day (P for quadratic trend = .001).

Conclusions

In this large prospective cohort study, there was a J-shaped relationship between chocolate consumption and HF incidence. Moderate chocolate consumption was associated with a lower rate of HF hospitalization or death, but the protective association was not observed among individuals consuming ≥1 serving per day.

Journal Subject Codes: Etiology: Epidemiology, Heart failure: Congestive

Section snippets

Study cohort

The Cohort of Swedish Men (COSM) is a population-based cohort study established in central Sweden (Västmanland and Örebro counties) and includes 48,850 men aged 45-79 years old in 1997, when baseline data were collected.19., 20. The cohort includes questionnaire-based information about such modifiable lifestyle factors as diet, physical activity, smoking, weight, use of dietary supplements, some prescribed drugs, and alcohol. Cardiovascular and other diseases as well as surgical procedures and

Results

During 14 years of follow-up, 2,157 men were hospitalized for first HF (n = 1,901) or died of HF (n =256), corresponding to a crude rate of 5.2 cases per 1000 person-years. Median chocolate intake was 1-3 servings per month. Compared with men reporting no chocolate intake, men who ate more chocolate had higher total daily energy intake, were more likely to be never smokers and have university-level education, and were less likely to be previously diagnosed with hypertension (Table I).

Compared with

Discussion

In this prospective study, we found that moderate habitual chocolate intake in men was associated with a lower rate of HF hospitalization or death, but the protective association was not observed with intake of ≥1 serving per day.

Chocolate has been shown to have multiple benefits to cardiovascular health, possibly mediated in part through their high concentration of plant-derived antioxidants called flavonoids.7., 30. Chocolate provides a significant dietary source of flavonoids, which are also

Conflicts of interest

All authors have no conflicts to declare. The authors are solely responsible for the design and conduct of this study, all study analyses and drafting and editing of the paper.

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In the another cohort study, Steinhaus et al. over 14 years of follow-up, compared with subjects who did not intake chocolate usually, the intake between 3 and 6 servings of dark chocolate per week decreased the risk of heart failure or mortality by 18%, whereas there was no protection with consumption ≥1 serving per day. In this study 256 deaths due to heart failure was noticed within 2157 hospitalizations from 31,917 Swedish men of 45–79 years [38]. A recent meta-analysis showed a 14% reduced risk of heart failure with chocolate intake less than seven portions weekly, corroborating with the mentioned results [35].
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The lack of association was corroborated in a complementary meta-analysis. These findings for chocolate consumption and AF contrast with previous observations of inverse associations of moderate chocolate consumption with risk of ischemic heart disease,10 heart failure,12 and stroke13,14 in the Swedish cohorts and in meta-analyses of all available data from cohort studies.7,10,11,13 Evidence from randomized controlled trials indicates that cocoa product consumption improves endothelial function and may modestly reduce blood pressure and insulin resistance.5,6
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View full text

Clinical InvestigationChocolate intake and incidence of heart failure: Findings from the Cohort of Swedish Men

Aims

Methods

Results

Conclusions

Section snippets

Study cohort

Results

Discussion

Conflicts of interest

Am J Clin Nutr

Am J Clin Nutr

J Nutr

Am J Cardiol

Am J Clin Nutr

Am J Clin Nutr

J Nutr

Free Radic Biol Med

Am J Clin Nutr

J Am Coll Cardiol

Heart disease and stroke statistics—2013 update: a report from the American Heart Association

Circulation

Clinical epidemiology of heart failure: public and private health burden

Eur Heart J

Circulation

Cocoa and health: a decade of research

Br J Nutr

Chocolate and prevention of cardiovascular disease: a systematic review

Nutr Metab (Lond)

The emerging role of flavonoid-rich cocoa and chocolate in cardiovascular health and disease

Nutr Rev

Dark chocolate consumption improves leukocyte adhesion factors and vascular function in overweight men

FASEB J

Effect of cocoa on blood pressure

Cochrane Database Syst Rev

Low vs. higher-dose dark chocolate and blood pressure in cardiovascular high-risk patients

Am J Hypertens

Effect of cocoa products on blood pressure: systematic review and meta-analysis

Am J Hypertens

Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives

Hypertension

Effect of cocoa and tea intake on blood pressure: a meta-analysis

Arch Intern Med

Chocolate consumption in relation to blood pressure and risk of cardiovascular disease in German adults

Eur Heart J

Clinical Investigation
Chocolate intake and incidence of heart failure: Findings from the Cohort of Swedish Men