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Coronary heart disease is the leading cause of death worldwide and accounts for almost 70 000 deaths annually in the UK alone.1 The modifiable lifestyle risk factors contributing to coronary heart disease have been extensively researched and they include poor dietary choices, physical inactivity and smoking. In contrast to the often recommended heart healthy diet, it has perhaps been both a surprise and a delight to many that recent research has suggested that chocolate in both its milky and dark disguises may have a protective effect against coronary artery disease.2 ,3
Cocoa has the richest flavanol content of all foods on a per-weight basis including high levels of epicatechin.4 The health benefits of eating chocolate have increasingly been attributed to their flavan-3-ol content, found in the highest concentration in dark chocolate.5 Indeed, flavanol-rich cocoa is thought to activate nitric oxide synthesis which could explain findings of beneficial effects of chocolate on endothelial cell function and blood pressure control.4 ,5 Chocolate consumption has also been associated with improved platelet function, reduced insulin resistance and a healthier serum lipid profile.4 This may be attributed to the high levels of oleic acid found in dark chocolate—a monounsaturated fat known to have a positive effect on blood lipids.
The most recent Swedish study found an inverse association between chocolate consumption and myocardial infarction risk with those eating ≥3–4 servings/week of chocolate having a 13% relative risk reduction (HR 0.87 (95% CI 0.77 to 0.98, p=0.04)) compared with non-consumers.2 The authors acknowledge that chocolate consumption was only assessed by a single question in a baseline food frequency questionnaire with no distinction made between types or quantity. This is particularly important bearing in mind the possible dose-dependent …
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