title: Chocolate intake and incidence of heart failure: Findings from the Cohort of Swedish Men.
abstract: The objective of this study was to evaluate the association of chocolate consumption and heart failure (HF) in a large population of Swedish men.
  
  
  METHODS
  We conducted a prospective cohort study of 31,917 men 45-79 years old with no history of myocardial infarction, diabetes, or HF at baseline who were participants in the population-based Cohort of Swedish Men study. Chocolate consumption was assessed through a self-administrated food frequency questionnaire. Participants were followed for HF hospitalization or mortality from January 1, 1998, to December 31, 2011, using record linkage to the Swedish inpatient and cause-of-death registries.
  
  
  RESULTS
  During 14 years of follow-up, 2,157 men were hospitalized (n=1,901) or died from incident HF (n=256). Compared with subjects who reported no chocolate intake, the multivariable-adjusted rate ratio of HF was 0.88 (95% CI 0.78-0.99) for those consuming 1-3 servings per month, 0.83 (95% CI 0.72-0.94) for those consuming 1-2 servings per week, 0.82 (95% CI 0.68-0.99) for those consuming 3-6 servings per week, and 1.10 (95% CI 0.84-1.45) for those consuming ≥1 serving per day (P for quadratic trend=.001).
  
  
  CONCLUSIONS
  In this large prospective cohort study, there was a J-shaped relationship between chocolate consumption and HF incidence. Moderate chocolate consumption was associated with a lower rate of HF hospitalization or death, but the protective association was not observed among individuals consuming ≥1 serving per day. Journal Subject Codes: Etiology: Epidemiology, Heart failure: Congestive.
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth, Israel Deaconess Medical Center, Harvard Medical School, 375 Longwood Ave, Boston, MA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Steinhaus
authors.affiliation: Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth, Israel Deaconess Medical Center, Harvard Medical School, 375 Longwood Ave, Boston, MA; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mostofsky
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL.
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.affiliation: Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth, Israel Deaconess Medical Center, Harvard Medical School, 375 Longwood Ave, Boston, MA; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA.
authors.forename: Kirsten S
authors.initials: KS
authors.lastname: Dorans
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
authors.forename: Niclas
authors.initials: N
authors.lastname: Håkansson
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
authors.forename: Alicja
authors.initials: A
authors.lastname: Wolk
authors.affiliation: Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth, Israel Deaconess Medical Center, Harvard Medical School, 375 Longwood Ave, Boston, MA; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA. Electronic address: mmittlem@bidmc.harvard.edu.
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
mesh_terms: D000368:Aged; D000069956:Chocolate / Q000009:adverse effects; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012306:Risk; D013548:Sweden / Q000453:epidemiology