title: Chocolate consumption and mortality following a first acute myocardial infarction: the Stockholm Heart Epidemiology Program.
abstract: OBJECTIVE
  To assess the long-term effects of chocolate consumption amongst patients with established coronary heart disease.
  
  
  METHODS
  In a population-based inception cohort study, we followed 1169 non-diabetic patients hospitalized with a confirmed first acute myocardial infarction (AMI) between 1992 and 1994 in Stockholm County, Sweden, as part of the Stockholm Heart Epidemiology Program. Participants self-reported usual chocolate consumption over the preceding 12 months with a standardized questionnaire distributed during hospitalization and underwent a health examination 3 months after discharge. Participants were followed for hospitalizations and mortality with national registries for 8 years.
  
  
  RESULTS
  Chocolate consumption had a strong inverse association with cardiac mortality. When compared with those never eating chocolate, the multivariable-adjusted hazard ratios were 0.73 (95% confidence interval, 0.41-1.31), 0.56 (0.32-0.99) and 0.34 (0.17-0.70) for those consuming chocolate less than once per month, up to once per week and twice or more per week respectively. Chocolate consumption generally had an inverse but weak association with total mortality and nonfatal outcomes. In contrast, intake of other sweets was not associated with cardiac or total mortality.
  
  
  CONCLUSIONS
  Chocolate consumption was associated with lower cardiac mortality in a dose dependent manner in patients free of diabetes surviving their first AMI. Although our findings support increasing evidence that chocolate is a rich source of beneficial bioactive compounds, confirmation of this strong inverse relationship from other observational studies or large-scale, long-term, controlled randomized trials is needed.
authors.affiliation: Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. imre.janszky@ki.se
authors.forename: I
authors.initials: I
authors.lastname: Janszky
authors.forename: K J
authors.initials: KJ
authors.lastname: Mukamal
authors.forename: R
authors.initials: R
authors.lastname: Ljung
authors.forename: S
authors.initials: S
authors.lastname: Ahnve
authors.forename: A
authors.initials: A
authors.lastname: Ahlbom
authors.forename: J
authors.initials: J
authors.lastname: Hallqvist
mesh_terms: D000367:Age Factors; D000368:Aged; D002099:Cacao; D016022:Case-Control Studies; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000378:metabolism / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000378:metabolism* / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012306:Risk; D012737:Sex Factors; D020521:Stroke / Q000378:metabolism / Q000401:mortality; D013548:Sweden