title: Habitual chocolate consumption and the risk of incident heart failure among healthy men and women.
abstract: We aimed to examine the association between chocolate intake and the risk of incident heart failure in a UK general population. We conducted a systematic review and meta-analysis to quantify this association.
  
  
  
  We used data from a prospective population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Chocolate intake was quantified based on a food frequency questionnaire obtained at baseline (1993-1997) and incident heart failure was ascertained up to March 2009. We supplemented the primary data with a systematic review and meta-analysis of studies which evaluated risk of incident heart failure with chocolate consumption. A total of 20,922 participants (53% women; mean age 58 ± 9 years) were included of whom 1101 developed heart failure during the follow up (mean 12.5 ± 2.7 years, total person years 262,291 years). After adjusting for lifestyle and dietary factors, we found 19% relative reduction in heart failure incidence in the top (up to 100 g/d) compared to the bottom quintile of chocolate consumption (HR 0.81 95%CI 0.66-0.98) but the results were no longer significant after controlling for comorbidities (HR 0.87 95%CI 0.71-1.06). Additional adjustment for potential mediators did not attenuate the results further. We identified five relevant studies including the current study (N = 75,408). The pooled results showed non-significant 19% relative risk reduction of heart failure incidence with higher chocolate consumption (HR 0.81 95%CI 0.66-1.01).
  
  
  
  Our results suggest that higher chocolate intake is not associated with subsequent incident heart failure.
authors.affiliation: School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Keele Cardiovascular Research Group, Institute for Science & Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom.
authors.forename: C S
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Department of Population Health & Primary Care, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
authors.forename: Y K
authors.initials: YK
authors.lastname: Loke
authors.affiliation: Department of Population Health & Primary Care, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
authors.forename: A A
authors.initials: AA
authors.lastname: Welch
authors.affiliation: Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors.forename: R N
authors.initials: RN
authors.lastname: Luben
authors.affiliation: Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors.forename: M A H
authors.initials: MA
authors.lastname: Lentjes
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Boekholdt
authors.affiliation: Department III of Internal Medicine, Heart Centre of the University of Cologne, Cologne, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Pfister
authors.affiliation: Keele Cardiovascular Research Group, Institute for Science & Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom.
authors.forename: M A
authors.initials: MA
authors.lastname: Mamas
authors.affiliation: Medical Research Council Epidemiology Unit, Cambridge, United Kingdom.
authors.forename: N J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors.forename: K-T
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom. Electronic address: phyo.myint@abdn.ac.uk.
authors.forename: P K
authors.initials: PK
authors.lastname: Myint
mesh_terms: D000368:Aged; D002182:Candy / Q000009:adverse effects; D000069956:Chocolate / Q000009:adverse effects; D004739:England / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D064368:Healthy Volunteers; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Chocolate; Cocoa; Epidemiology; Heart failure; Meta-analysis