Cardioprotective effects of cocoa: Clinical evidence from randomized clinical intervention trials in humans

Authors

  • Sara Arranz,

    1. Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona, Spain
    2. CIBER de Fisiopatologia de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
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  • Palmira Valderas-Martinez,

    1. Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona, Spain
    2. CIBER de Fisiopatologia de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
    3. RETIC Alimentación saludable, Instituto de Salud Carlos III, Madrid, Spain
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  • Gemma Chiva-Blanch,

    1. Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona, Spain
    2. CIBER de Fisiopatologia de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
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  • Rosa Casas,

    1. Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona, Spain
    2. CIBER de Fisiopatologia de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
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  • Mireia Urpi-Sarda,

    1. Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona, Spain
    2. Nutrition and Food Science Department, XaRTA, INSA, Pharmacy Faculty, University of Barcelona, Barcelona, Spain
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  • Rosa M. Lamuela-Raventos,

    1. CIBER de Fisiopatologia de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
    2. RETIC Alimentación saludable, Instituto de Salud Carlos III, Madrid, Spain
    3. Nutrition and Food Science Department, XaRTA, INSA, Pharmacy Faculty, University of Barcelona, Barcelona, Spain
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  • Ramon Estruch

    Corresponding author
    1. CIBER de Fisiopatologia de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
    2. RETIC Alimentación saludable, Instituto de Salud Carlos III, Madrid, Spain
    • Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Correspondence: Dr. Ramon Estruch, Department of Internal Medicine, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain

E-mail: restruch@clinic.ub.es

Fax: +34-932279365

Abstract

Cocoa is an important source of polyphenols, which comprise 12–18% of its total dry weight. The major phenolic compounds in cocoa and cocoa products are mainly flavonoids such as epicatechin, catechin, and proanthocyanidins. These products contain higher amounts of flavonoids than other polyphenol-rich foods. However, the bioavailability of these compounds depends on other food constituents and their interactions with the food matrix. Many epidemiological and clinical intervention trials have concluded that the ingestion of flavonoids reduces the risk factors of developing cardiovascular disease. This review summarizes the new findings regarding the effects of cocoa and chocolate consumption on cardiovascular risk factors. The mechanisms involved in the cardioprotective effects of cocoa flavonoids include reduction of oxidative stress, inhibition of low-density lipoproteins oxidation and platelet aggregation, vasodilatation of blood vessels, inhibition of the adherence of monocytes to vascular endothelium, promotion of fibrinolysis, and immunomodulatory and anti-inflammatory activity. Scientific evidence supports a cause and effect relationship between consumption of cocoa flavonoids and the maintenance of normal endothelium-dependent vasodilation, which contributes to normal blood flow. However, larger randomized trials are required to definitively establish the impact of cocoa and cocoa products consumption on hard cardiovascular outcomes.

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