Cocoa Flavonols Might Reduce Cardiovascular Events

Cocoa is made from the bean of the cacao tree, Theobroma cacao, and has a long history of medicinal use and potential health benefits based on its flavonol and procyanidin content also found in tea, grapes, wine, and other foods.

The cocoa extract also contains methylxanthines such as theobromine and caffeine, which may enhance the vascular and central nervous system effects of cocoa flavonols.

Studies have examined the cardiovascular effects of cocoa and cocoa products. They have shown cardiovascular and cardiometabolic benefits, improving endothelium-dependent vasodilation, blood pressure, inflammation, and platelet activation. However, no large-scale trials have evaluated all the potential of cocoa beans on cardiovascular outcomes. 

Recently, a team performed a large randomized trial using a cocoa flavonol supplement and the effect on cardiovascular disease (CVD) among older adults. The study appears in The American Journal of Clinical Nutrition. 

Cocoa and Reduced Mortality from CVD   

The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) included over 21,000 older adults randomly assigned to receive either treatment or placebo. It showed that 3.6 years of cocoa flavanol supplementation was associated with a 10% lower rate of total CV events, including myocardial infarction, stroke, revascularization, unstable angina, and CVD death. 

The most statistically significant result from the study was a 27% reduction in cardiovascular disease death.

After making additional analyses comparing those participants adherent to cocoa flavonols to those adherent to placebo found a significant 15% reduction of total CV events, while also reducing the risk of major CV events, such as stroke plus CVD death, by 16%. 


Howard D. Sesso, et al. Effect of cocoa flavanol supplementation for the prevention of cardiovascular disease events: the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial. 2022. Am. J. Clin. Nutr. 

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