Our toolbox for preventing cardiovascular disease just became a whole lot richer.
The Latin name for cacao, Theobroma, literally means “food of the gods.” Dark chocolate is produced by adding fat and sugar to cacao, or cocoa, which contains flavonoids that exert antihypertensive, anti-inflammatory, and antithrombotic effects.
This month, Ella Zomer and colleagues of Monash University in Melbourne, Australia, attempted to put a dollar amount on dark chocolate’s health benefits (BMJ 2012;344:e3657).
Using statistical modeling, the investigators evaluated the health effects and costs associated with daily plain dark chocolate consumption compared with no such consumption in a population of 2,013 people with hypertension who met criteria for metabolic syndrome, but who had no history of cardiovascular disease and were not receiving antihypertensive therapy.
The analysis focused on people in the Australian Diabetes Obesity and Lifestyle (AusDiab) study and the effects of chocolate were informed by randomized trials and meta-analyses.
Assuming 100% adherence, daily dark chocolate consumption was estimated to prevent 70 non-fatal and 15 fatal cardiovascular events per 10,000 people treated over 10 years. This would occur at a cost of $52,500 per year of life saved when $42 was spent per person per year on dark chocolate.
Available evidence suggests that dark chocolate needs to be at least 60%-70% cacao to exert beneficial health effects. Higher levels of cacao adds bitterness, an acquired taste that may not be tolerated by many of our American patients raised on milk chocolate. Clinical recommendations need to take into consideration that palatable dark chocolate contains fat and sugar that may increase the risk for weight gain, but dark chocolate increases satiety, which may help decrease snacking.
The general notion that dark chocolate may be beneficial for our patients is provocative, but taking it a step further and actually prescribing chocolate is tricky given that the optimal dose is unclear. Many of us may be reluctant to encourage chocolate consumption in our patients with metabolic syndrome for fear that they will over do it. Perhaps its time to extrapolate these findings and test the health benefits of dark chocolate for ourselves.
Jon O. Ebbert, M.D., is a professor of medicine and a primary care clinician at the Mayo Clinic in Rochester, Minn. He reports having no conflicts of interest. The opinions expressed are solely those of the author. Contact him at ebbert.jon@mayo.edu.