Habitual chocolate consumption and risk of cardiovascular disease among healthy men and women

Chun Shing Kwok, S Matthijs Boekholdt, Marleen A H Lentjes, Yoon K Loke, Robert N Luben, Jessica K Yeong, Nicholas J Wareham, Phyo K Myint, Kay-Tee Khaw

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To examine the association between chocolate intake and the risk of future cardiovascular events.

METHODS: We conducted a prospective study using data from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Habitual chocolate intake was quantified using the baseline food frequency questionnaire (1993-1997) and cardiovascular end points were ascertained up to March 2008. A systematic review was performed to evaluate chocolate consumption and cardiovascular outcomes.

RESULTS: A total of 20 951 men and women were included in EPIC-Norfolk analysis (mean follow-up 11.3±2.8 years, median 11.9 years). The percentage of participants with coronary heart disease (CHD) in the highest and lowest quintile of chocolate consumption was 9.7% and 13.8%, and the respective rates for stroke were 3.1% and 5.4%. The multivariate-adjusted HR for CHD was 0.88 (95% CI 0.77 to 1.01) for those in the top quintile of chocolate consumption (16-99 g/day) versus non-consumers of chocolate intake. The corresponding HR for stroke and cardiovascular disease (cardiovascular disease defined by the sum of CHD and stroke) were 0.77 (95% CI 0.62 to 0.97) and 0.86 (95% CI 0.76 to 0.97). The propensity score matched estimates showed a similar trend. A total of nine studies with 157 809 participants were included in the meta-analysis. Higher compared to lower chocolate consumption was associated with significantly lower CHD risk (five studies; pooled RR 0.71, 95% CI 0.56 to 0.92), stroke (five studies; pooled RR 0.79, 95% CI 0.70 to 0.87), composite cardiovascular adverse outcome (two studies; pooled RR 0.75, 95% CI 0.54 to 1.05), and cardiovascular mortality (three studies; pooled RR 0.55, 95% CI 0.36 to 0.83).

CONCLUSIONS: Cumulative evidence suggests that higher chocolate intake is associated with a lower risk of future cardiovascular events, although residual confounding cannot be excluded. There does not appear to be any evidence to say that chocolate should be avoided in those who are concerned about cardiovascular risk.

Original languageEnglish
Pages (from-to)1279-1287
Number of pages9
JournalHeart
Volume101
Issue number16
Early online date15 Jun 2015
DOIs
Publication statusPublished - 2015

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Cardiovascular Diseases
Coronary Disease
Stroke
Chocolate
Propensity Score
Meta-Analysis
Neoplasms
Outcome Assessment (Health Care)
Prospective Studies
Food
Mortality

Keywords

  • Cardiovascular Disease
  • Stroke
  • Chocolate
  • CORONARY HEART DISEASE

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kwok, C. S., Boekholdt, S. M., Lentjes, M. A. H., Loke, Y. K., Luben, R. N., Yeong, J. K., ... Khaw, K-T. (2015). Habitual chocolate consumption and risk of cardiovascular disease among healthy men and women. Heart, 101(16), 1279-1287. https://doi.org/10.1136/heartjnl-2014-307050

Habitual chocolate consumption and risk of cardiovascular disease among healthy men and women. / Kwok, Chun Shing; Boekholdt, S Matthijs; Lentjes, Marleen A H; Loke, Yoon K; Luben, Robert N; Yeong, Jessica K; Wareham, Nicholas J; Myint, Phyo K; Khaw, Kay-Tee.

In: Heart, Vol. 101, No. 16, 2015, p. 1279-1287.

Research output: Contribution to journalArticle

Kwok, CS, Boekholdt, SM, Lentjes, MAH, Loke, YK, Luben, RN, Yeong, JK, Wareham, NJ, Myint, PK & Khaw, K-T 2015, 'Habitual chocolate consumption and risk of cardiovascular disease among healthy men and women', Heart, vol. 101, no. 16, pp. 1279-1287. https://doi.org/10.1136/heartjnl-2014-307050
Kwok CS, Boekholdt SM, Lentjes MAH, Loke YK, Luben RN, Yeong JK et al. Habitual chocolate consumption and risk of cardiovascular disease among healthy men and women. Heart. 2015;101(16):1279-1287. https://doi.org/10.1136/heartjnl-2014-307050
Kwok, Chun Shing ; Boekholdt, S Matthijs ; Lentjes, Marleen A H ; Loke, Yoon K ; Luben, Robert N ; Yeong, Jessica K ; Wareham, Nicholas J ; Myint, Phyo K ; Khaw, Kay-Tee. / Habitual chocolate consumption and risk of cardiovascular disease among healthy men and women. In: Heart. 2015 ; Vol. 101, No. 16. pp. 1279-1287.
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T1 - Habitual chocolate consumption and risk of cardiovascular disease among healthy men and women

AU - Kwok, Chun Shing

AU - Boekholdt, S Matthijs

AU - Lentjes, Marleen A H

AU - Loke, Yoon K

AU - Luben, Robert N

AU - Yeong, Jessica K

AU - Wareham, Nicholas J

AU - Myint, Phyo K

AU - Khaw, Kay-Tee

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2015

Y1 - 2015

N2 - OBJECTIVE: To examine the association between chocolate intake and the risk of future cardiovascular events.METHODS: We conducted a prospective study using data from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Habitual chocolate intake was quantified using the baseline food frequency questionnaire (1993-1997) and cardiovascular end points were ascertained up to March 2008. A systematic review was performed to evaluate chocolate consumption and cardiovascular outcomes.RESULTS: A total of 20 951 men and women were included in EPIC-Norfolk analysis (mean follow-up 11.3±2.8 years, median 11.9 years). The percentage of participants with coronary heart disease (CHD) in the highest and lowest quintile of chocolate consumption was 9.7% and 13.8%, and the respective rates for stroke were 3.1% and 5.4%. The multivariate-adjusted HR for CHD was 0.88 (95% CI 0.77 to 1.01) for those in the top quintile of chocolate consumption (16-99 g/day) versus non-consumers of chocolate intake. The corresponding HR for stroke and cardiovascular disease (cardiovascular disease defined by the sum of CHD and stroke) were 0.77 (95% CI 0.62 to 0.97) and 0.86 (95% CI 0.76 to 0.97). The propensity score matched estimates showed a similar trend. A total of nine studies with 157 809 participants were included in the meta-analysis. Higher compared to lower chocolate consumption was associated with significantly lower CHD risk (five studies; pooled RR 0.71, 95% CI 0.56 to 0.92), stroke (five studies; pooled RR 0.79, 95% CI 0.70 to 0.87), composite cardiovascular adverse outcome (two studies; pooled RR 0.75, 95% CI 0.54 to 1.05), and cardiovascular mortality (three studies; pooled RR 0.55, 95% CI 0.36 to 0.83).CONCLUSIONS: Cumulative evidence suggests that higher chocolate intake is associated with a lower risk of future cardiovascular events, although residual confounding cannot be excluded. There does not appear to be any evidence to say that chocolate should be avoided in those who are concerned about cardiovascular risk.

AB - OBJECTIVE: To examine the association between chocolate intake and the risk of future cardiovascular events.METHODS: We conducted a prospective study using data from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Habitual chocolate intake was quantified using the baseline food frequency questionnaire (1993-1997) and cardiovascular end points were ascertained up to March 2008. A systematic review was performed to evaluate chocolate consumption and cardiovascular outcomes.RESULTS: A total of 20 951 men and women were included in EPIC-Norfolk analysis (mean follow-up 11.3±2.8 years, median 11.9 years). The percentage of participants with coronary heart disease (CHD) in the highest and lowest quintile of chocolate consumption was 9.7% and 13.8%, and the respective rates for stroke were 3.1% and 5.4%. The multivariate-adjusted HR for CHD was 0.88 (95% CI 0.77 to 1.01) for those in the top quintile of chocolate consumption (16-99 g/day) versus non-consumers of chocolate intake. The corresponding HR for stroke and cardiovascular disease (cardiovascular disease defined by the sum of CHD and stroke) were 0.77 (95% CI 0.62 to 0.97) and 0.86 (95% CI 0.76 to 0.97). The propensity score matched estimates showed a similar trend. A total of nine studies with 157 809 participants were included in the meta-analysis. Higher compared to lower chocolate consumption was associated with significantly lower CHD risk (five studies; pooled RR 0.71, 95% CI 0.56 to 0.92), stroke (five studies; pooled RR 0.79, 95% CI 0.70 to 0.87), composite cardiovascular adverse outcome (two studies; pooled RR 0.75, 95% CI 0.54 to 1.05), and cardiovascular mortality (three studies; pooled RR 0.55, 95% CI 0.36 to 0.83).CONCLUSIONS: Cumulative evidence suggests that higher chocolate intake is associated with a lower risk of future cardiovascular events, although residual confounding cannot be excluded. There does not appear to be any evidence to say that chocolate should be avoided in those who are concerned about cardiovascular risk.

KW - Cardiovascular Disease

KW - Stroke

KW - Chocolate

KW - CORONARY HEART DISEASE

U2 - 10.1136/heartjnl-2014-307050

DO - 10.1136/heartjnl-2014-307050

M3 - Article

C2 - 26076934

VL - 101

SP - 1279

EP - 1287

JO - Heart

JF - Heart

SN - 1355-6037

IS - 16

ER -