Abstract 18692: High Flavanol Dark Chocolate Reduces NT-proBNP in Patients with Chronic Heart Failure

Abstract

Background: Endothelial dysfunction in patients with heart failure (HF) has been linked to a worse prognosis. High flavanol cocoa products improve endothelial function, but it has yet to be established whether such changes are sufficient to confer medical benefit. We investigated whether high flavanol dark chocolate (HFDC) reduces the severity of HF by measuring changes in amino-terminal pro-B type natriuretic peptide (NT-proBNP). Methods: Patients with HF and a history of ischemic heart disease (n = 32), stable on optimal medication according to standard guidelines, were randomized to consume 50 g per day of either HFDC or low flavanol dark chocolate (LFDC) for 4 weeks, and then crossed over to consume the alternative dark chocolate for a further 4 week. The flavanol contents of the HFDC and LFDC were 1094 and 95 mg/50 g. NT-proBNP, blood pressure, and aortic pulse waveform derived from radial artery applanation tonometry were assessed at baseline, after each 4-week treatment phase, and at follow-up 4 weeks after completion of chocolate consumption. Results: 24 subjects completed the study. After 4 weeks consumption of HFDC, NT-proBNP was significantly lower compared to baseline (P = 0.016), LFDC (P = 0.019) and at follow-up (P = 0.004). After HFDC, diastolic blood pressure (DBP) was decreased compared to LFDC (mean decrease ± SD; -7 ± 10 mmHg, P = 0.003 and compared to baseline measurements (-4 ± 9 mmHg, P = 0.047). Figure 1 shows a comparison of mean changes in DBP and NT-proBNP after HFDC compared to baseline, LFDC and follow-up values. Mean decrease in NT-proBNP was >30% in 12 patients. Conclusions: Reductions in NT-proBNP and blood pressure after HFDC are consistent with a decrease in vascular resistance resulting in reduced left ventricular afterload. Post treatment reductions of NT-proBNP >30% have previously been associated with improved outcome in patients with HF. Hence, long-term benefits of high flavanol interventions in HF merit further investigation. -->