Abstract
BackgroundWe aimed to examine the association between chocolate intake and the risk of incident heart failure in a UK general population. We conducted a systematic review and meta-analysis to quantify this association. Methods and resultsWe used data from a prospective population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Chocolate intake was quantified based on a food frequency questionnaire obtained at baseline (1993–1997) and incident heart failure was ascertained up to March 2009. We supplemented the primary data with a systematic review and meta-analysis of studies which evaluated risk of incident heart failure with chocolate consumption. A total of 20,922 participants (53% women; mean age 58 ± 9 years) were included of whom 1101 developed heart failure during the follow up (mean 12.5 ± 2.7 years, total person years 262,291 years). After adjusting for lifestyle and dietary factors, we found 19% relative reduction in heart failure incidence in the top (up to 100 g/d) compared to the bottom quintile of chocolate consumption (HR 0.81 95%CI 0.66–0.98) but the results were no longer significant after controlling for comorbidities (HR 0.87 95%CI 0.71–1.06). Additional adjustment for potential mediators did not attenuate the results further. We identified five relevant studies including the current study (N = 75,408). The pooled results showed non-significant 19% relative risk reduction of heart failure incidence with higher chocolate consumption (HR 0.81 95%CI 0.66–1.01). ConclusionsOur results suggest that higher chocolate intake is not associated with subsequent incident heart failure.
Highlights
Cocoa, one of the main ingredients in plain chocolate, is an important dietary source of flavonoids which are believed to have cardiovascular benefits
Higher chocolate consumption was significantly associated with a younger age and a lower systolic blood pressure, as well as a lower proportion of people with hypertension, myocardial infarction and diabetes, but associated with higher energy intake
In this large prospective population based cohort study, systematic review and meta-analysis, we found the association between chocolate consumption and reduced subsequent risk of heart failure but this was not sufficiently robust after adjusting for potential confounders
Summary
One of the main ingredients in plain chocolate, is an important dietary source of flavonoids which are believed to have cardiovascular benefits. Both observational and trial evidence have shown that chocolate consumption is associated with a reduction in blood pressure [1e4]. We have recently reported that habitual chocolate consumption is associated with lower cardiovascular risk [14]. These factors in combination may reduce the incidence of heart failure with higher chocolate consumption
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