IntroductionCurrently, the rediscovery beneficial effects of cocoa and dark chocolate focus on its nutritional value as dietary and therapeutic supplements 1, 2, associated with its polyphenol content (resveratrol, anthocyanins, flavonols and catechins) 3, wich reduce the incidence of cardiovascular diseases 4 and cancer by deacreasing oxidative stress (antioxidant effect) 5, 6.ObjectiveSearch and analyze the evidence in available scientific articles on the effect of dark chocolate consumption on health.MethodologyA literature review of various scientific articles, obtained from the SciELO and PubMed bases, was carried out. The included articles were obtained since the year 2001. The article search was carried out from August 26 to October 7, 2019. The keywords used for the search were: dark chocolate, health, cardiovascular disease, polyphenols. Finally 19 articles were included.ResultsVarious studies show that dark chocolate and cocoa contain a significant amount of polyphenols, mainly flavonols 5, 7. Its consumption leads to an increase in bioactive nitric oxide (NO) lowering blood pressure (BP) 7. They also improve insulin sensitivity 8, 9, decrease total plasma cholesterol, in particular very low density cholesterol (LDL), modulate cell apoptosis at the endothelial level, improve cytokine balance and vascular inflammation (inhibit COX and LPO) 1, 6, 8, inhibit platelet aggregation and endothelin‐1 synthesis (ET‐1) 6, 10.ConclusionThe flavonols of dark chocolate and cocoa mainly produce a decrease in BP mediated by NO; In addition, they regulate inflammatory and metabolic processes that result in the improvement of chronic, cardiometabolic and vascular diseases. Chocolate should be considered as a recommendation in balanced nutrition.Support or Funding InformationINSTITUTION: UPAEP Studies on the consumption of dark chocolate and its effect on health (systematic reviews and available clinical trials) Author Year Study Sample Metodology Efect Buitrago‐Lopez A, et al. 2001 Meta‐analysis 114009 in 7 cohort studies. Age range: >18 años Number of CV events between consumption extremes was compared. Decreased 37% CVD (RR: 0.63; CI: 0.44–0.90) Decreased stroke 29%. Taubert D, et al. 2003 Randomized cross clinical trial 13 BMI 21.9–26.2 with mild isolated systolic hypertension. Age range: 55–63 years Consumption of dark chocolate of 100 g per day (500 mg of polyphenols) for 14 days. Participants had significantly lower systolic and diastolic pressures. The systolic mean decreased by 5.1 mmHg, and the diastolic mean decreased by 1.8 mmHg Grassi D, et al. 2005 Clinical trial crossed 20 Age range: 18–50 years Healthy 100 g dark chocolate (88 mg flavanols). Daily BP measurement. BP decrease (24‐hour systolic −11.9 +/− 7.7 mmHg, P <0.0001; 24‐hour diastolic −8.5 +/− 5.0 mmHg, P <0.0001). Taubert D, et al. 2007 Clinical trial parallel 44 Age range: >18 years Normotensive or AHT 6.3 g of dark or white chocolate for 18 weeks. Daily BP measurement. SBP: −2.9 (IC: −4.5, −1.3) mmHg DBP: −1.9 (CI: −2.9, −0.9) mmHg The prevalence of AHT decreased from 86% to 68%. Hooper L, et al. 2008 Meta‐analysis 277 in 13 studies Age range: >18 years Healthy BP changes between intervention (dark chocolate) and control. Very heterogeneous SBP: −5.88 (−9.55, −2.21) I2= 81% DBP: −3.30 (−5.77, −0.83) I2= 70% Reid K, et al. 2009 Meta‐analysis 36 Age range: 22–73 years Prehypertensive 8 week follow up. Dark chocolate, tomato extract and placebo No changes within or between groups Nogueira LdeP, et al. 2012 Clinical trial parallel 20 Age range: 18–60 years AHT + BMI: 25–34.9 kg/m2 50 g/day of dark chocolate (70%). Peripheral arterial tonometry (Endo‐PAT 200). Increased endothelial function of 1.94 (IC: 1.76 – 2.12) to 2.22 (IC: 2.14 – 2.3) Mogollon JA, et al. 2013 Clinical trial parallel 44 Age range: 18–37 years Pregnant women Dark Chocolate vs. Chocolate “Placebo” for 12 weeks. No differences in the change of BP or FMD Tsang C, et al. 2019 Clinical trial 26 Age range: 23–55 years Improve salivary cortisol levels. 25 g/day of dark chocolate with high polyphenol content (500 mg of flavonoids). Total daily cortisol, morning cortisol and cortisol/cortisone ratio were significantly decrease (p <0.001). CV: cardiovascular, CVD: CVD: cerebrovascular disease, RR: relative risk, BP: blood pressure, PAS: systolic blood pressure, PAD: diastolic blood pressure, AHT: arterial hypertension, BMI: body mass index, FMD: flow mediated dilation, I2: heterogeneity index.