Cocoa, Blood Pressure, and Cardiovascular Health

Abstract

High blood pressure is an important risk factor for cardiovascular disease and cardiovascular events worldwide. Clinical and epidemiological studies suggest that cocoa-rich products reduce the risk of cardiovascular disease. According to this, cocoa has a high content in polyphenols, especially flavanols. Flavanols have been described to exert favorable effects on endothelium-derived vasodilation via the stimulation of nitric oxide-synthase, the increased availability of l-arginine, and the decreased degradation of NO. Cocoa may also have a beneficial effect by protecting against oxidative stress alterations and via decreased platelet aggregation, decreased lipid oxidation, and insulin resistance. These effects are associated with a decrease of blood pressure and a favorable trend toward a reduction in cardiovascular events and strokes. Previous meta-analyses have shown that cocoa-rich foods may reduce blood pressure. Long-term trials investigating the effect of cocoa products are needed to determine whether or not blood pressure is reduced on a chronic basis by daily ingestion of cocoa. Furthermore, long-term trials investigating the effect of cocoa on clinical outcomes are also needed to assess whether cocoa has an effect on cardiovascular events. A 3 mmHg systolic blood pressure reduction has been estimated to decrease the risk of cardiovascular and all-cause mortality. This paper summarizes new findings concerning cocoa effects on blood pressure and cardiovascular health, focusing on putative mechanisms of action and "nutraceutical " viewpoints.

Cocoa, Blood Pressure, and Vascular Function

“…In this context, several epidemiological studies suggest a strong correlation between daily cocoa intake and better cardiovascular outcome in different population settings ( 19 – 21 ). Clinical interventional studies demonstrated a positive effect of flavanol-rich cocoa or chocolate intake on BP reduction and improvement in microvascular and macrovascular function ( 116 , 117 ). In vitro and in vivo studies identified increased NO availability, increased NO synthase activity, and inhibition of ACE as putative mechanisms of this beneficial effect ( 118 ).…”

Dietary Cocoa Prevents Aortic Remodeling and Vascular Oxidative Stress in Diabetic Rats

“…T2D is associated with functional and structural damages to the arterial wall that result in macrovascular complications and cardiovascular disease . Several interventional studies strongly suggest a potential role of cocoa intake in the maintenance of optimal vascular condition in healthy individuals and in situations of cardiovascular risk such as hypercholesterolemia and hypertension or during normal aging . Consequently, in the present study we evaluated the potential protective effect of cocoa on vascular stiffness and remodeling in a situation of high cardiovascular risk such as diabetes.…”

“…The favourable effect of flavonoids on arteries is emerging and it has been recently described that flavonoids could be associated with improved measures of vascular function, and in particular with arterial stiffness . Accordingly, cocoa flavanols have been related to numerous cardioprotective effects, including lowering of blood pressure (BP), anti‐inflammatory and anti‐atherosclerotic effects, as well as antidiabetic actions . Despite these facts, the effect of cocoa flavanols on arterial function in a situation of high cardiovascular risk such as diabetes remains unclear.…”

Chocolate, Air Pollution and Children's Neuroprotection: What Cognition Tools should be at Hand to Evaluate Interventions?

“…Overall, evidence suggests that cardiovascular effects are important in neuroprotection, specifically with regard to the impact on endothelial dysfunction (Jumar and Schmieder, 2016 ). To this end, cocoa flavonols improve vasodilatory capacity in high and low cardiovascular risk subjects (Heiss et al, 2003 ; Ferri et al, 2015 ; Jumar and Schmieder, 2016 ; Sansone et al, 2015 ). Given the obesity epidemic, and comorbid health problems in Mexico and the USA, cocoa and cocoa flavonoids may positively affect the pathophysiological mechanisms involved in insulin resistance and endothelial dysfunction, with potential benefits in the prevention of cardiometabolic diseases (Grassi et al, 2015a , b ).…”