Chocolate and Heart Failure

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Alvin B. Lin, MD, FAAFP

Associate Professor of Family and Community Medicine, University of Nevada School of Medicine

Adjunct Professor of Family Medicine and Geriatrics, Touro University Nevada College of Medicine

Advisory Medical Director, Infinity Hospice Care

Medical Director, Lions HealthFirst Foundation

Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at


Well, Valentine's Day is just a week away, so I thought I'd review a randomized, double-blind, placebo-controlled study published just under 2 months ago in European Heart Journal looking at the beneficial effect of flavanol-rich chocolate on patients with heart failure. Specifically, the authors compared flavanol-rich chocolate to cocoa-liquor-free control chocolate, both manufactured by Nestle, the former commercially available as Nestle Noir Intense, in patients with typical systolic heart failure.

Vascular effects were measured three times, acutely 12 hours after initial intake of 1 bar and chronically after 2 weeks and 4 weeks of daily consumption of 2 bars. And the bars? The Nestle Noir Intense contained 10.5g of sugar and 17.9g of fat per 40g serving with 70% cocoa content. The cocoa-liquor-free control chocolate weighed in at 28.4g per serving but was equivalent in both sugar and fat content.

Now, in case you wondering if I have a financial stake in Nestle, I don't, at least not directly to my knowledge as all my investments are in mutual funds and who knows what the fund managers are buying & selling on a daily basis. So in an attempt at fair play, I direct your attention to (and, no I don't have a financial stake here either) or any other retail website devoted to chocolate. The purpose of describing the chocolate used in this study in such detail is to allow you to replicate the study or at least find similar chocolates close by at home. Unfortunately, milk chocolate and chocolate candy probably won't suffice.

Granted the study size was small, just 10 patients in each group, average age 58 to 60 years of age and predominantly male with ejection fraction 30% to 35%. Yet, the authors noted statistically significant improvements in endothelial and platelet function, both acutely and after 4 weeks consumption of flavanol-rich chocolate compared to cocoa-liquor-free chocolate.

The next question is whether these results can be reproduced in a larger group and, more importantly, whether any clinically significant benefits can be demonstrated (eg decrease in mortality, or at least improvement in physical performance measures and/or quality of life). In the meantime, look for flavanol-rich chocolate for your Valentine, especially if he or she has heart failure.