Cocoa Intake, Blood Pressure, and Cardiovascular Mortality : the Zutphen eldery study

G.M. Buijsse, E.J.M. Feskens, F.J. Kok, D. Kromhout

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376 Citations (Scopus)


Background: Small, short-term, intervention studies indicate that cocoa-containing foods improve endothelial function and reduce blood pressure. We studied whether habitual cocoa intake was cross-sectionally related to blood pressure and prospectively related with cardiovascular mortality. Methods: Data used were of 470 elderly men participating in the Zutphen Elderly Study and free of chronic diseases at baseline. Blood pressure was measured at baseline and 5 years later, and causes of death were ascertained during 15 years of follow-up. Habitual food consumption was assessed by the cross-check dietary history method in 1985, 1990, and 1995. Cocoa intake was estimated from the consumption of cocoa-containing foods. Results: One third of the men did not use cocoa at baseline. The median cocoa intake among users was 2.11 g/d. After adjustment, the mean systolic blood pressure in the highest tertile of cocoa intake was 3.7 mm Hg lower (95% confidence interval [CI], ¿7.1 to ¿0.3 mm Hg; P = .03 for trend) and the mean diastolic blood pressure was 2.1 mm Hg lower (95% CI, ¿4.0 to ¿0.2 mm Hg; P = .03 for trend) compared with the lowest tertile. During follow-up, 314 men died, 152 of cardiovascular diseases. Compared with the lowest tertile of cocoa intake, the adjusted relative risk for men in the highest tertile was 0.50 (95% CI, 0.32-0.78; P = .004 for trend) for cardiovascular mortality and 0.53 (95% CI, 0.39-0.72; P <.001) for all-cause mortality. Conclusion: In a cohort of elderly men, cocoa intake is inversely associated with blood pressure and 15-year cardiovascular and all-cause mortality
Original languageEnglish
Pages (from-to)411-417
JournalArchives of Internal Medicine
Issue number4
Publication statusPublished - 2006


  • coronary-heart-disease
  • flavanol-rich cocoa
  • dark chocolate
  • platelet-function
  • dependent vasodilation
  • mononuclear-cells
  • healthy humans
  • consumption
  • risk
  • susceptibility

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