Cocoa Flavanols Improves Markers of Cardiovascular Health

PD Dr. med. Christian Heiß Sektion Angiologie Oberarzt, Facharzt für Innere Medizin und Angiologie Klinik für Kardiologie, Pneumologie und Angiologie Universitätsklinikum Düsseldorf Interview with:
PD Dr. med. Christian Heiß
Sektion Angiologie
Oberarzt, Facharzt für Innere Medizin und Angiologie
Klinik für Kardiologie, Pneumologie und Angiologie
Universitätsklinikum Düsseldorf

Medical Research: What is the background for this study? What are the main findings?

Response:  There is an extensive body of research which has shown that cocoa flavanols can improve healthy blood vessel function. However, for the most part, these investigations have focused on high-risk individuals like smokers and people that have already been diagnosed with conditions like hypertension and coronary heart disease. The purpose of the FLAVIOLA HEALTH study, published in BJN, was to find out whether the beneficial cardiovascular effects of cocoa flavanols would hold true for the general population.

The studies demonstrated that consumption of cocoa flavanols significantly improves several of the hallmarks of cardiovascular health, including increased flow-mediated vasodilation. Flow-mediated vasodilation is a sign of improved endothelial function and has been shown by some studies to be associated with decreased risk of developing cardiovascular disease. In addition, consuming flavanols decreased both systolic and diastolic blood pressure, and improved the blood cholesterol profile by decreasing total cholesterol, decreasing LDL cholesterol, and increasing HDL cholesterol.

The results demonstrate that flavanols are effective at mitigating age-related changes in blood vessels, and could thereby reduce the risk of cardiovascular disease in healthy individuals.

Medical Research: What should clinicians and patients take away from your report? Medical Research: What recommendations do you have for future research as a result of this study?

Response:   The results of the study in the BJN and a related study published in the journal Age earlier in the year are an important step in determining whether a high-cocoa-flavanol diet can maintain cardiovascular health as we age.

Further research is needed to determine what effect cocoa flavanol consumption has on clinical endpoints like heart attack, what amount of cocoa flavanols creates the documented effects, when the improvements begin and how long-lasting the effects are. Longer-term studies, such as the 5-year COcoa Supplement and Multivitamin Outcomes Study (COSMOS) of 18,000 men and women, are already underway to investigate the health potential of flavanols on a much larger scale. Ancillary studies as part of COSMOS will focus on a broad range of potential benefits of cocoa flavanols on brain health, including memory, decision-making skills, mood, and cognitive performance, as well as metabolic health.

It is worth noting that this research focused specifically on cocoa flavanols and not on chocolate for a number of reasons. Chocolate can be part of a balanced diet but its overall nutrient composition means that it is not suitable as a health food. There are also wide variations in the flavanol content of commercially available chocolates as flavanols are usually destroyed by normal processing methods (roasting, alkalization, etc.). Given the amount of chocolate that you would need to consume to reach the amount of cocoa flavanols used in this study, this shouldn’t be seen as a recommendation to consume chocolate. This is why the FLAVIOLA consortium that conducted the research used a special cocoa flavanol test product created for the study by Mars, Incorporated in order to deliver a standardised amount of flavanols within a drink that is nutritionally suitable (low in fats, sugars, calories) for use in research and in the context of health maintenance. We hope that others build on this research and FLAVIOLA’s other findings and to develop novel and nutritionally-responsible delivery mechanisms for cocoa flavanols.

Maintaining cardiovascular health involves a number of lifestyle decisions, including exercise, drinking alcohol in moderation and not smoking. Healthy diets are also crucial and these proof-of-concept studies published in the journals BJN and Age show that diets high in flavanols could play a role in this. Eventually, this will enable the development of optimised diets rich in bioactives like cocoa flavanols and dietary recommendations aimed at the maintenance of cardiovascular health. One of FLAVIOLA’s aims is to lay the foundation for the development of evidence-based dietary recommendations and healthful food/beverage products that retain the benefits of flavanols for cardiovascular health.

For people diagnosed with medical conditions such as hypertension, it is important to always consult with your doctor when determining the best treatment. Whether someone is recommended to take medication will depend on blood pressure level and risk of developing cardiovascular disease, but lifestyle changes such as diet, not smoking and exercise are recommended to all. These studies did not investigate the role of flavanols in people with existing medical conditions.


Roberto Sansone, Ana Rodriguez-Mateos, Jan Heuel, David Falk, Dominik Schuler, Rabea Wagstaff, Gunter G. C. Kuhnle, Jeremy P. E. Spencer, Hagen Schroeter, Marc W. Merx, Malte Kelm, Christian Heiss. Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial: the Flaviola Health Study. British Journal of Nutrition, 2015; 1 DOI: 10.1017/S0007114515002822

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