Eating chocolates lowers CAD risk among veterans

Veterans who regularly eat chocolates appear to have a reduced risk of coronary artery disease (CAD), except for those with type 2 diabetes, a study has shown.

“In this large patient population receiving care in a national integrated health care system, we showed, to our knowledge for the first time, that chocolate consumption was associated with a lower risk of CAD and that such relation was not modified by age, body mass index (BMI), race, sex, diabetes, or hypertension,” the researchers said.

Data from the Million Veteran Program (MVP) participants who completed the food frequency section of the MVP Lifestyle Survey and were free of CAD at the time of survey completion were analysed in this study. Electronic records were used to assess CAD events during follow-up (International Statistical Classification of Diseases Ninth Revision codes 410–411 and 413–414, and Tenth Revision codes I20–I25 except I25.2). A Cox proportional hazard model was fitted to estimate the relative risk (RR) of CAD.

A total of 188,447 MVP enrolees (mean age 64±12.0 years) had survey data, of whom 90 percent were men. During a mean follow-up of 3.2 years, the crude incidence rates per 1,000 person-years for fatal and nonfatal CAD events or coronary procedures were 20.2 for regular chocolate (28.3 g/serving) consumption of <1 serving/mo, 17.5 for 1–3 servings/mo, 16.7 for 1 serving/wk, 17.1 for 2–4 servings/wk, and 16.9 for ≥5 servings/wk. [Am J Clin Nutr 2021;113:1137-1144]

After adjusting for age, sex, race, and lifestyle factors, the hazard ratios were 1.00 (reference), 0.92 (95 percent confidence interval [CI], 0.87–0.96), 0.88 (95 percent CI, 0.83–0.93), 0.89 (95 percent CI, 0.84–0.95), and 0.89 (95 percent CI, 0.84–0.96), respectively (p<0.0001 for linear trend).

Secondary analysis of 47,265 diabetic veterans revealed no decreasing trend in CAD mortality among those who consumed ≥1 serving of chocolate a month relative to those who consumed <1 serving/mo.

Of note, the amount of chocolate consumption necessary to provide a protective effect against CAD varied across studies.

“We observed that any consistent chocolate intake among veterans was associated with a significantly lower risk of CAD, but a recent meta-analysis of 14 studies found that only chocolate consumption <100 g/wk was associated with a lower risk of CVD,” the researchers said. “Higher amounts suggested [an] increased risk of adverse health effects with higher sugar consumption.” [Heart 2019;105:49-55]

Moreover, a dose-response meta-analysis showed a small inverse association between a 10-g daily increase in chocolate consumption and CAD risk (RR, 0.96, 95 percent CI, 0.93–0.99). [Eur J Nutr 2020;59:389-397]

Several randomized controlled trials, as well as observational and experimental studies, reported the beneficial effects of chocolate consumption on CAD risk factors. In particular, chocolate and cocoa had been shown to correlate with better insulin sensitivity, reduced risk of type 2 diabetes, and lower blood pressure. [Eur J Clin Nutr 2017;71:1088-1093; J Agric Food Chem 2008;56:7877-7884; Am J Clin Nutr 2015;101:362-367; BMC Med 2010;8:39; Am J Hypertens 2010;23:97-103]

“The discrepancy in the minimum and maximum amounts of chocolate needed to observe … [a] health effect might be clarified with future studies that focus on cocoa content and flavonoid amounts in the types of chocolate consumed because these compounds can vary widely across different chocolates,” the researchers said.