Cocoa intake, blood pressure, and cardiovascular mortality - The Zutphen Elderly Study

Background: Small, short-term, intervention studies indicate that cocoa-containing foods improve endothelial function and reduce blood pressure. We studied whether habitual cocoa intake was cross-sectionally related to blood pressure and prospectively related with cardiovascular mortality. Methods: Data used were of 470 elderly men participating in the Zutphen Elderly Study and free of chronic diseases at baseline. Blood pressure was measured at baseline and 5 years later, and causes of death were ascertained during 15 years of follow-up. Habitual food consumption was assessed by the cross-check dietary history method in 1985, 1990, and 1995. Cocoa intake was estimated from the consumption of cocoa-containing foods. Results: One third of the men did not use cocoa at baseline. The median cocoa intake among users was 2.11 g/d. After adjustment, the mean systolic blood pressure in the highest tertile of cocoa intake was 3.7 mm Hg lower (95% confidence interval [CI], - 7.1 to - 0.3mmHg; P=. 03 for trend) and the mean diastolic blood pressure was 2.1 mm Hg lower ( 95% CI, - 4.0 to - 0.2 mm Hg; P=. 03 for trend) compared with the lowest tertile. During follow-up, 314 men died, 152 of cardiovascular diseases. Compared with the lowest tertile of cocoa intake, the adjusted relative risk for men in the highest tertile was 0.50 ( 95% CI, 0.32- 0.78; P=. 004 for trend) for cardiovascular mortality and 0.53 ( 95% CI, 0.39- 0.72; P <. 001) for all-cause mortality. Conclusion: In a cohort of elderly men, cocoa intake is inversely associated with blood pressure and 15-year cardiovascular and all-cause mortality.