Chocolate and health: On the vascular effects of flavanols in cocoa

Cardiovascular disease (CVD), including stroke, is a leading cause of death and disability in developed countries. Hypertension is central in CVD as well as numerous other health problems, including diabetes and obesity-related diseases. Strategies employed for the prevention or treatment of hypertension and CVD range from pharmacological approaches to lifestyle adjustment, with diet being one of the most important variables that can be altered. In this paper we review evidence concerning the potential positive health effects of chocolate and cocoa products, especially with respect to vascular health and hypertension. Studies have shown that the consumption of flavanol-rich chocolate and cocoa products can decrease blood pressure and promote vasodilation. Evidence will be reviewed that supports the concept that the flavanols in cocoa and chocolate increase the vasodilator nitric oxide (NO), and that this NO contributes to the positive vascular effects of these foods.