Chocolate Consumption: Benefits in Cardiovascular Disease

Keywords
Cardiovascular Diseases/mortality; Myocardial Infarction/ physiopathology; Flavonoids; Polyphenols; Chocolate

The major risk factors for cardiovascular diseases (CVDs) are directly related to endothelial dysfunction, reduced bioavailability of nitric oxide, vasoconstriction, oxidative stress, and inflammation.¹ Several studies have been stimulating the use of non-pharmacological strategies to reduce these risk factors. In this sense, some nutrients and bioactive compounds in foods have demonstrated beneficial effects. Chocolate, for example, has gained attention for its content of cocoa, a polyphenols-rich food, and flavanols.²

In the paper entitled “Association between chocolate consumption and severity of first infarction”, Duarte et al.,³ found that patients with the first acute myocardial infarction (AMI) who consumed chocolate, showed a low Syntax index, indicating low complexity of coronary lesions. The authors also demonstrated a negative correlation between Syntax and the amount of chocolate consumed, and an association between chocolate consumption and absence of systemic arterial hypertension and diabetes. The cardioprotective effects of polyphenols present in chocolate have been studied, and a series of results supported the protective effects of cocoa and chocolate intake on CVDs. These protective effects are associated with vasodilation, improvement of endothelial function, platelet aggregation, increase in HDL and reduction in LDL levels.⁴

Recently, studies have demonstrated the relationship between gut microbiota and CVD, and it would be interesting to determine the possible effects of cocoa polyphenols on these microbioma. Flavanols are absorbed in the small intestine, metabolized in the liver and excreted in the urine.^5-8 A studied conducted in healthy individuals showed that consumption of a high-cocoa flavanol beverage significantly increased the growth of Lactobacillus spp. and Bifidobacterium spp. in comparison to a low cocoa flavanol drink,⁶ promoting anti-inflammatory effects in these individuals.

Obesity is one of the main risk factors for CVDs. Experimental studies revealed that cocoa could reduce visceral adipose tissue and synthesis of fatty acids, enhance thermogenesis and appetite response, and increase the expression of adiponectin and glucose transporter.^4,9-11

In conclusion, polyphenols present in chocolate seem to be a promising therapeutic strategy for CVD patients due to its activity in inflammatory modulation, endothelial dysfunction, gut microbiota, lipid status and obesity. In my point of view, further clinical studies are necessary to compare the best sources of polyphenols, chocolate or cocoa, and to determine the most effective way to offer these bioactive compounds to patients.

References

• ¹
  Popolo A, Autore G, Pinto A, Marzocco S. Oxidative stress in patients with cardiovascular disease and chronic renal failure. Free Radic Res. 2013:47(5):346-56.
• ²
  Gammone MA, Efthymakis K, Pluchinotta FR, Bergante S, Tettamanti G, Riccioni G, D'Orazio N. Impact of chocolate on the cardiovascular health. Front Biosci9landmark Ed.) 2018 Jan 1; 23:852-64.
• ³
  Duarte HM, Oliveira MR, Jung R, Silva RL, Fattah T, Moreira D, Association between of first infarction. Int J Cardiovasc Sci. 2019 [online].ahead of print. PP.0-0.
• ⁴
  Magrone T, Russo MA, Jirillo E. Cocoa and Dark Chocolate Polyphenols: From Biology to Clinical Applications. Front Immunol.[Landmark Ed]. 2018 Jan 17; 9(8):677.
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  Tzounis X, Vulevic J, Kuhnle GG, George T, Leonczak J, Gibson GR, et al. Flavanol monomer-induced changes to the human faecal microflora. Br J Nutr. 2008; 99(4):782-92.
• ⁶
  Tzounis X, Rodriguez-Mateos A, Vulevic J, Gibson GR, Kwik-Uribe C, Spencer JP. Prebiotic evaluation of cocoa-derived flavanols in healthy humans by using a randomized, controlled, double-blind, crossover intervention study. Am J Clin Nutr. 2011; 93(1):62-72.
• ⁷
  Wiese S, Esatbeyoglu T, Winterhalter P, Kruse HP, Winkler S, Bub A, et al. Comparative biokinetics and metabolism of pure monomeric, dimeric, and polymeric flavan-3-ols: a randomized cross-over study in humans. Mol Nutr Food Res. 2015; 59(4):610-21.
• ⁸
  Massot-Cladera M, P.rez-Berezo T, Franch A, Castell M, P.rez-Cano FJ. Cocoa modulatory effect on rat faecal microbiota and colonic crosstalk. Arch Biochem Biophys. 2012; 527(2):105-12.
• ⁹
  Matsui N, Ito R, Nishimura E, Yoshikawa M, Kato M, Kamei M, et al. Ingested cocoa can prevent high-fat diet-induced obesity by regulating the expression of genes for fatty acid metabolism. Nutrition. 2005; 21(5):594-601.
• ¹⁰
  Massolt ET, van Haard PM, Rehfeld JF, Posthuma EF, van der Veer E, Schweitzer DH. Appetite suppression through smelling of dark chocolate correlates with changes in ghrelin in young women. Regul Pept. 2010; 161(1-3):81-6.
• ¹¹
  Ali F, Ismail A, Kersten S. Molecular mechanisms underlying the potential antiobesity related diseases effect of cocoa polyphenols. Mol Nutr Food Res. 2014; 58(1):33-48.

Publication Dates

• Publication in this collection
  24 Oct 2019
• Date of issue
  Nov-Dec 2019