Chocolate consumption and risk of cardiovascular diseases: a meta-analysis of prospective studies

Tian, Xiaoping; Liu, Yu; Sun, Xizhuo; Wang, Bingyuan; Zhao, Yang; Liu, Dechen; Zhang, Dongdong; Liu, Xuejiao; Zhang, Rui-Yuan; Sun, Hai; Liu, Fei-Yan; Xu, Chen; Cheng, Cheng; Liu, Leilei; Zhou, Qionggui; Zhang, Ming; Hu, Dongsheng

doi:10.1136/heartjnl-2018-313131

Cited by 45 publications

(39 citation statements)

References 35 publications

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“…Previous meta-analyses focused predominantly on CVD [7,8,[54][55][56][57] and found an inverse relation. Interestingly, one meta-analysis reported an inverse non-linear association between chocolate and risk of overall CVD, with the peak of a protective association at 45 g of chocolate per week [7], which is equivalent of 6-7 g/d. However, results of the meta-analyses on CHD varied with the included endpoints.…”

Section: Discussionmentioning

confidence: 97%

“…However, results of the meta-analyses on CHD varied with the included endpoints. If only myocardial infarction (MI) was analyzed, a recently published meta-analysis suggested a 16% lower risk in high versus low comparison, as well as a 1.9% decrease per 20 g/week of chocolate in a dose-response manner [7]. If CHD was analyzed, high chocolate consumption was associated with a 10% lower risk of CHD in high versus low comparisons [8].…”

Section: Discussionmentioning

confidence: 99%

“…To evaluate the credibility of evidence for the association between chocolate consumption and risk of all-cause mortality, CHD, stroke, heart failure, T2D, CRC, and hypertension, a recently developed NutriGrade scoring system was implemented (max 10 points). This tool is based on the following criteria for prospective studies: (1) risk of bias, study quality, study limitations (up to 2 points), (2) precision (up to 1 point), (3) heterogeneity (up to 1 point), (4) directness (up to 1 point), (5) publication bias (up to 1 point), (6) funding bias (up to 1 point), (7) effect size (up to 2 points), and (8) dose-response (up to 1 point) [27]. The following categorization of the calculated score is recommended to interpret the credibility of evidence: high (≥ 8 points), moderate (6 to < 8 points), low (4 to < 6 points), and very low (0 to < 4 points).…”

Section: Credibility Of the Evidencementioning

confidence: 99%

“…Previous meta-analyses of prospective studies have shown that chocolate intake is associated with decreased risk of coronary heart disease (CHD), T2D, heart failure (HF), and stroke [7][8][9]. Moreover, dose-response meta-analyses revealed a non-linear association with the highest protective effect of 2-3 servings of chocolate per week for T2D and HF risk as well as a small decrease of risk with higher intakes for CHD and stroke [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Chocolate and risk of chronic disease: a systematic review and dose-response meta-analysis

et al. 2019

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Purpose Evidence for the association between chocolate intake and risk of chronic diseases is inconclusive. Therefore, we aimed to synthesize and evaluate the credibility of evidence on the dose-response association between chocolate consumption with risk of all-cause mortality, coronary heart disease (CHD), stroke, heart failure (HF), type 2 diabetes (T2D), colorectal cancer (CRC), and hypertension. Methods Prospective studies were searched until July 2018 in PubMed, Embase, and Web of Science. Random-effects metaanalyses comparing highest versus lowest intake categories, linear, and non-linear dose-response analyses were conducted. The credibility of evidence was evaluated with the NutriGrade scoring-system. Results Overall, 27 investigations were identified (n = 2 for all-cause mortality, n = 9 for CHD, n = 8 for stroke, n = 6 for HF, n = 6 for T2D, n = 2 for hypertension and CRC, respectively). No associations with HF (RR 0.99, 95% CI 0.94, 1.04) and T2D (RR 0.94, 95% CI 0.88, 1.01) per each 10 g/day increase in chocolate intake were observed in the linear dose-response meta-analyses. However, a small inverse association for each 10 g/daily increase could be shown for the risk of CHD (RR 0.96, 95% CI 0.93, 0.99), and stroke (RR 0.90, 95% CI 0.82, 0.98). The credibility of evidence was rated either very low (all-cause mortality, HF, T2D, CRC or hypertension) or low (CHD, stroke). Conclusion Chocolate consumption is not related to risk for several chronic diseases, but could have a small inverse association with CHD and stroke. Our findings are limited by very low or low credibility of evidence, highlighting important uncertainty for chocolate-disease associations.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Credibility Of the Evidencementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chocolate and risk of chronic disease: a systematic review and dose-response meta-analysis

et al. 2019

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“…Dosed according to body weight, aspirin use may mitigate an athlete's concern about becoming a statistic on the up-slope of the U-shaped curve showing incremental cardiovascular risk with exercise intensity, perhaps like having one's cake (if chocolate) and eating it too. [43][44][45][46][47][48] A predominance of current clinical evidence in our view suggests that aspirin use guided by coronary artery calcium scores can decrease cardiovascular morbidity and mortality in middle-aged male endurance athletes, as demonstrated in women at high risk for preterm preeclampsia with lowdose aspirin. 49 Such use is similar to aspirin for reducing exertional sudden cardiac death due to coronary heart disease in US firefighters in a case-controlled study with findings similar to acute cardiac event registries in runners.…”

mentioning

confidence: 99%

Aspirin to Prevent Sudden Cardiac Death in Athletes with High Coronary Artery Calcium Scores

Siegel

Noakes

2019

The American Journal of Medicine

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While proficient cardiac resuscitation has improved survival following cardiac arrest during road races in Japan, this accomplishment does not address coronary artery disease as the underlying cause of an increasing frequency of cardiac arrest in middle-aged men during marathons and ironman triathlons in the United States since the year 2000. Based on the high prevalence of subclinical coronary artery disease by cardiac computed tomography in endurance athletes with low conventional cardiac risk-factor profiles, we recommend coronary artery calcium scores as a more reliable and independent predictor of incident cardiac events, including death, as validated among adults aged 30-46 years. Scores of over 100 Agatston units indicate a 10-year cardiac risk of 7.5%, at which additional measures for primary prevention are recommended, including aspirin, as shown conclusively to reduce first myocardial infarctions in same-aged men in a prospective double-blind controlled trial. Targeted screening for subclinical coronary atherosclerosis with coronary artery calcium scores is prudent to guide appropriately dosed aspirin use to mitigate the increasing frequency of sports-related sudden cardiac death due to plaque rupture.

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Evaluation of the Quality of Evidence of the Association of Foods and Nutrients With Cardiovascular Disease and Diabetes

et al. 2022

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IMPORTANCEPoor diet is a leading global factor associated with cardiometabolic disease (CMD).Understanding the quality of evidence of the associations between specific dietary factors and CMD, including effect size (relative risk [RR]) and uncertainty, is essential to guide policy and consumer actions to achieve healthy diet and public health goals. OBJECTIVETo assess the quality of evidence of the associations between specific dietary factors and CMD as well as the quantitative evidence for RRs and the uncertainty of these risk estimates.EVIDENCE REVIEW PubMed and the reference lists of eligible articles were searched between May 1, 2015, and February 26, 2021, for systematic reviews with meta-analyses of randomized clinical trials and prospective cohort studies that analyzed the consumption of 1 or more of the dietary factors of interest; reported dose-response meta-analyses; included healthy adults; and assessed 1 or more of the outcomes of interest. Study characteristics and RR estimates were extracted in duplicate. For identified associations, quality of evidence was assessed using the Bradford-Hill criteria for causation. FINDINGS A total of 2058 potentially relevant reports were identified, from which 285 full-text articles were assessed for eligibility. The final selection of articles included 28 meta-analyses representing 62 associations between diet and CMD. Among these associations, 10 foods, 3 beverages, and 12 nutrients had at least probable evidence of associations with coronary heart disease, stroke, and/or diabetes. Most RRs ranged from 0.87 to 0.96 per daily serving change for protective associations and from 1.06 to 1.15 per daily serving change for harmful associations. Most identified associations were protective (n = 38) and a smaller number were harmful (n = 24), with a higher risk associated with higher intake. CONCLUSIONS AND RELEVANCEThis systematic review summarized the current quality of evidence of the associations of specific dietary factors with coronary heart disease, stroke, and diabetes. These findings may inform dietary guidance, the assessment of disease burden in specific populations, policy setting, and future research.

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Chocolate consumption and risk of cardiovascular diseases: a meta-analysis of prospective studies

Abstract: Chocolate consumption may be associated with reduced risk of CVD at <100 g/week consumption. Higher levels may negate the health benefits and induce adverse effects associated with high sugar consumption.

Cited by 45 publications

References 35 publications

Chocolate and risk of chronic disease: a systematic review and dose-response meta-analysis

Chocolate and risk of chronic disease: a systematic review and dose-response meta-analysis

Aspirin to Prevent Sudden Cardiac Death in Athletes with High Coronary Artery Calcium Scores

Evaluation of the Quality of Evidence of the Association of Foods and Nutrients With Cardiovascular Disease and Diabetes

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