Epidemiologic studies have shown inverse associations between dietary polyphenols and mortality from coronary heart disease. Small, short-term, intervention studies have indicated that cocoa-containing foods may provide many cardiovascular benefits including reducing blood pressure, inhibiting platelet function, preventing lipid oxidation, reducing LDL, increasing HDL, improving endothelial function, increasing insulin sensitivity, reducing insulin resistance and reducing inflammation.
Dark chocolate, but not white chocolate, was observed to significantly improve endothelial and platelet function in healthy smokers, with increased flow-mediated dilatation, increased total antioxidant status and reduced shear stress dependent platelet function seen 2-8 hours after ingestion (Hermann et al 2006). Dark chocolate has also been shown to increase insulin sensitivity and decrease blood pressure in healthy people (Grassi et al 2005a). Similar results were obtained in a RCT using 100 g of dark chocolate containing approximately 500 mg polyphenols which was consumed daily for 1 5 days. Chocolate was found to decrease DBP by -11.9 ± 7.7 mmHg, decrease serum LDL-cholesterol from 3.4 to 3.0 mmol/L, improve flow-mediated dilation, and reduce insulin resistance and increase insulin sensitivity in patients with newly diagnosed essential hypertension (Grassi et al 2005b). Similarly, a study of male soccer players found that consumption of 105 g of flavanol-containing milk chocolate (168 mg of flavanols) for 14 days decreased DBP (-5 mmHg), mean blood pressure (-5 mmHg), plasma cholesterol (-11 %), LDL-cholesterol (-1 5%), malondialdehyde (-12%), urate (-11%) and lactate dehydrogenase activity (-11%), and increased vitamin E/cholesterol (+12%) (Fraga et al 2005).
As yet there are no published long-term RCT or intervention studies of cocoa with hard clinical end-points (Maron 2004). The cardiovascular benefits of cocoa are
supported, however, in a 1 5-year epidemiological study of 470 elderly men, which found that cocoa intake was inversely associated with blood pressure and 1 5-year cardiovascular and all-cause mortality. This study found a 50% reduction in cardiovascular-related death and all-cause mortality in the highest fertile of cocoa intake compared to the lowest fertile, suggesting that the pharmacological actions described for cocoa do, in fact, translate into clinical benefits (Buijsse et al 2006).
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