title: Cardiovascular effects of flavanol-rich chocolate in patients with heart failure.
abstract: OBJECTIVE
  Flavanol-rich chocolate (FRC) is beneficial for vascular and platelet function by increasing nitric oxide bioavailability and decreasing oxidative stress. Congestive heart failure (CHF) is characterized by impaired endothelial and increased platelet reactivity. As statins are ineffective in CHF, alternative therapies are a clinical need. We therefore investigated whether FRC might improve cardiovascular function in patients with CHF.
  
  
  RESULTS
  Twenty patients with CHF were enrolled in a double-blind, randomized placebo-controlled trial, comparing the effect of commercially available FRC with cocoa-liquor-free control chocolate (CC) on endothelial and platelet function in the short term (2 h after ingestion of a chocolate bar) and long term (4 weeks, two chocolate bars/day). Endothelial function was assessed non-invasively by flow-mediated vasodilatation of the brachial artery. Flow-mediated vasodilatation significantly improved from 4.98 ± 1.95 to 5.98 ± 2.32% (P = 0.045 and 0.02 for between-group changes) 2h after intake of FRC to 6.86 ± 1.76% after 4 weeks of daily intake (P = 0.03 and 0.004 for between groups). No effect on endothelial-independent vasodilatation was observed. Platelet adhesion significantly decreased from 3.9 ± 1.3 to 3.0 ± 1.3% (P = 0.03 and 0.05 for between groups) 2 h after FRC, an effect that was not sustained at 2 and 4 weeks. Cocoa-liquor-free CC had no effect, either on endothelial function or on platelet function. Blood pressure and heart rate did not change in either group.
  
  
  CONCLUSIONS
  Flavanol-rich chocolate acutely improves vascular function in patients with CHF. A sustained effect was seen after daily consumption over a 4-week period, even after 12 h abstinence. These beneficial effects were paralleled by an inhibition of platelet function in the presence of FRC only.
authors.affiliation: Cardiovascular Center, Cardiology University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland.
authors.forename: Andreas J
authors.initials: AJ
authors.lastname: Flammer
authors.forename: Isabella
authors.initials: I
authors.lastname: Sudano
authors.forename: Mathias
authors.initials: M
authors.lastname: Wolfrum
authors.forename: Rajeev
authors.initials: R
authors.lastname: Thomas
authors.forename: Frank
authors.initials: F
authors.lastname: Enseleit
authors.forename: Daniel
authors.initials: D
authors.lastname: Périat
authors.forename: Priska
authors.initials: P
authors.lastname: Kaiser
authors.forename: Astrid
authors.initials: A
authors.lastname: Hirt
authors.forename: Matthias
authors.initials: M
authors.lastname: Hermann
authors.forename: Mauro
authors.initials: M
authors.lastname: Serafini
authors.forename: Antoine
authors.initials: A
authors.lastname: Lévêques
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.forename: Georg
authors.initials: G
authors.lastname: Noll
authors.forename: Roberto
authors.initials: R
authors.lastname: Corti
mesh_terms: D055109:Ankle Brachial Index; D017704:Baroreflex / Q000187:drug effects; D015415:Biomarkers / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D002099:Cacao / Q000502:physiology*; D002182:Candy; D004311:Double-Blind Method; D004730:Endothelium, Vascular / Q000502:physiology; D005260:Female; D044948:Flavonols / Q000097:blood / Q000494:pharmacology*; D006333:Heart Failure / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects; D010973:Platelet Adhesiveness / Q000187:drug effects; D059808:Polyphenols / Q000097:blood; D014664:Vasodilation / Q000187:drug effects
chemical_list: D015415:Biomarkers; D044948:Flavonols; D059808:Polyphenols