2.2. Cocoa, Polyphenols and Cardiovascular Disease
Estruch, R.
Evidence based on epidemiological studies suggests that dietary flavonoids may play a critical role in the prevention of coronary heart disease (CHD).
Cocoa (Theobroma cacao) and its derived
products, such as chocolate, represent a very rich source of dietary flavonoids, containing a higher
content per serving than tea, red wine, legumes or fruits.
The health benefits associated with cocoa consumption have been related to their protective
effect mainly against cardiovascular diseases, but also in other diseases such as age-related cognitive
decline.
Observational studies have shown that the Kuna Indian population from the San Blas Islands
of Panama have very low rates of hypertension and cardiovascular disease, effects that have been
related to their high intake of cocoa. Clinical trials have also evaluated the effects of cocoa intake
on different cardiovascular risk factors.
Several studies have confirmed that cocoa intake reduces
blood pressure in normotensive and hypertensive subjects. In fact, dark chocolate intake increases nitric oxide (NO) generation, which leads to vasodilatation, and reduces systolic and diastolic blood
pressure by 2.77 mmHg and 2.20 mmHg, respectively, whereas white chocolate does not reduce blood
pressure.
Another mechanism by which flavanols may lower blood pressure is by the inhibition of
angiotensin-converting enzyme (ACE). In addition, cocoa intake improves lipid profile and insulin
sensibility, reduces platelet activity and function, and ameliorates endothelial dysfunction. At least
some of these other beneficial effects have also been attributed to anti-inflammatory and antioxidant
activities of polyphenols contained in cocoa.
Therefore, the addition of dark chocolate to a well-balanced healthy diet such as a Mediterranean
diet, offers a palatable option to preventing cardiovascular disease.
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