Cocoa, chocolate, and cardiovascular disease

Abstract

A significant body of evidence demonstrates that diets rich in fruits and vegetables promote health and attenuate, or delay, the onset of various diseases, including cardiovascular disease, diabetes, certain cancers, and several other age-related degenerative disorders. The concept that moderate chocolate consumption could be part of a healthy diet has gained acceptance in past years based on the health benefits ascribed to selected cocoa components. Specifically, cocoa as a plant and chocolate as food contain a series of chemicals that can interact with cell and tissue components, providing protection against the development and amelioration of pathological conditions. The most relevant effects of cocoa and chocolate have been related to cardiovascular disease. The mechanisms behind these effects are still under investigation. However, the maintenance or restoration of vascular NO production and bioavailability and the antioxidant effects are the mechanisms most consistently supported by experimental data. This review will summarize the most recent research on the cardiovascular effects of cocoa flavanols and related compounds.

Fig. 1

Chemical structure of flavanols and procyanidins. B2-dimer is a characteristic cocoa procyanidin formed by two (−)-epicatechin units linked by 4→8 bonds.

Fig. 2

Scheme relating flavanols (circles) with NO and superoxide (O₂ ⁻) metabolism in endothelial cells. Flavanols could act by: i) inhibiting NADPH oxidase-dependent superoxide production, ii) activating eNOS; iii) scavenging superoxide, H₂O₂, and other oxidants that mediate damage to cell components; and iv) modifying membrane-related events leading to changes in NO and superoxide production. NO generated in endothelial cells will diffuse outside the cell and reach smooth muscle cells where it will induce vascular relaxation.