Cacao (Theobroma cacao) as a tool for helping with Cardiovascular / heart health

This systematic review of chocolate and cocoa (Theobroma cacao), rich in polyphenols such as catechins and procyanidins, summarised their health effects, including beneficial cardiovascular, antioxidant, anti-inflammatory and metabolic outcomes.

This review describes how the antioxidant polyphenols (especially flavanols) of cocoa (Theobroma cacao) favourably affect endothelial vasodilation, blood pressure and platelet function, contributing to the cardiovascular benefits of chocolate.

This review summarises epidemiological evidence that intake of cocoa (Theobroma cacao) polyphenols is associated with reduced risk of cardiovascular disease, supporting a protective cardiovascular role of cocoa flavanols.

This review compiles the beneficial effects of cocoa (Theobroma cacao) polyphenols on human health, especially their antioxidant and anti-inflammatory actions and benefits for cardiovascular and metabolic health.

This critical review of cocoa (Theobroma cacao) polyphenols summarised in vitro, cell-culture and human evidence that cocoa flavanols improve endothelial function, blood pressure and other markers of vascular health.

In the COSMOS randomized clinical trial, cocoa (Theobroma cacao) flavanol supplementation did not significantly reduce total cardiovascular events but reduced cardiovascular mortality in secondary analyses, providing the largest trial evidence on cocoa flavanols and cardiovascular health.

Cocoa contains more phenolic antioxidants than most foods. Flavonoids, including catechin, epicatechin, and procyanidins predominate in antioxidant activity. The tricyclic structure of the flavonoids determines antioxidant effects that scavenge reactive oxygen species, chelate Fe2+ and Cu+, inhibit enzymes, and upregulate antioxidant defenses. The epicatechin content of cocoa is primarily responsible for its favorable impact on vascular endothelium via its effect on both acute and chronic upregulation of nitric oxide production. Other cardiovascular effects are mediated through anti-inflammatory effects of cocoa polyphenols, and modulated through the activity of NF-κB. Antioxidant effects of cocoa may directly influence insulin resistance and, in turn, reduce risk for diabetes. Further, cocoa consumption may stimulate changes in redox-sensitive signaling pathways involved in gene expression and the immune response. Cocoa can protect nerves from injury and inflammation, protect the skin from oxidative damage from UV radiation in topical preparations, and have beneficial effects on satiety, cognitive function, and mood. As cocoa is predominantly consumed as energy-dense chocolate, potential detrimental effects of overconsumption exist, including increased risk of weight gain. Overall, research to date suggests that the benefits of moderate cocoa or dark chocolate consumption likely outweigh the risks.

Cacao (Theobroma cacao) polyphenols influenced the regulation of apolipoproteins A-I and B in HepG2 and Caco-2 cells, suggesting a mechanism by which cocoa polyphenols improve lipid metabolism and cardiovascular risk.