Chocolate in Moderation Might Lower Risk of Coronary Heart Disease Interview with:
Anne Yuk-Lam Ho, MPH Million Veteran Program (MVP) Data Core MVP Coordinating Center VA Boston Healthcare SystemAnne Yuk-Lam Ho, MPH
Million Veteran Program (MVP) Data Core
MVP Coordinating Center
VA Boston Healthcare System What is the background for this study?

Response: Cardiovascular disease (CVD) has been the leading cause of morbidity and mortality globally. Prevalence of CVD among US population is approximately 7% which places huge burden on our healthcare systems. And prevalence of CVD is as high as 28% among veterans at the VA healthcare system as veteran users are primarily older male with more histories of comorbidities.  Most CVD risk factors including lipids and blood pressure can be controlled by lifestyle modifications, such as diet.

Chocolate is among dietary factors that play a role in modulating CVD risk factors is widely consumed in the US (~2.8 billion pounds annually. Although previous studies have reported beneficial effects of chocolate and/or cacao products (rich in flavonoids) on lipids, glucose metabolism and risk of diabetes, and lipids, little is known about the association of chocolate intake with coronary artery disease (CAD) among US veterans. Thus, sought to test the hypothesis that chocolate consumption is associated with a lower risk of CAD among xxx US veterans enrolled in the Million Veteran Program. What are the main findings?

Response: There were 188,477 MVP participants who were free of CAD at enrollment and provided information on dietary habits including frequency of chocolate consumption.  The average age at baseline was 64 years and 90% were men. During an average follow up of 3.2 years, 10,224 new cases of CAD occurred. Compared to veterans who consumed <1 serving/month of chocolate (28.3 g/serving), the risk of CAD was 8%, 12%, 11%, and 11% lower among veterans consuming 1–3 servings/month, 1 serving/week, 2–4 servings/week, and ≥5 servings/week, respectively, after controlling  for age, sex, race, and lifestyle factors. What should readers take away from your report?

Response: Since the risk reduction for CAD was about the same for chocolate consumption of 1 or more servings per week and given the potential risk for weight gain with excess calories from too much chocolate, the take home message from the study is that infrequent chocolate consumption such as 1 serving per week might lower the risk of CAD. What recommendations do you have for future research as a result of this work? 

Response: One of the limitations for this study was that we did not have detail information on types of chocolate and was not able to measure actual cocoa contents consumed by our veterans. While there is a wide variety of chocolate products on the market, in which cocoa contents may vary by type, brands and source. Further studies that can infer relationships of types of chocolate (i.e., dark versus white chocolate) and cardiovascular health would be beneficial to our veteran population. Future studies to confirm and explore potential biologic mechanisms by which chocolate may reduce CAD risk are also much needed. Is there anything else you would like to add? 

Response: It is important to note that even if chocolate were to be proven to reduce CAD risk, it is important to consume in moderation in a context of an overall health diet (i.e., a diet rich in fruits, vegetables, legumes, whole grains, and low-fat dairy and less in red meat, salt, and sugar-sweetened beverages).

None of the authors has conflict of interest to disclose.


Ho YL, Nguyen XM et al. Chocolate consumption and risk of coronary artery disease: the Million Veteran Program. The American Journal of Clinical Nutrition, nqaa427,



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Last Updated on March 9, 2021 by Marie Benz MD FAAD