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August 29, 2012
Letter to the Editor

Chocolate consumption and risk of stroke
A prospective cohort of men and meta-analysis

September 18, 2012 issue
79 (12) 1223-1229

Abstract

Objective:

To investigate the association between chocolate consumption and risk of stroke in men and conduct a meta-analysis to summarize available evidence from prospective studies of chocolate consumption and stroke.

Methods:

We prospectively followed 37,103 men in the Cohort of Swedish Men. Chocolate consumption was assessed at baseline using a food-frequency questionnaire. Cases of first stroke were ascertained from the Swedish Hospital Discharge Registry. For the meta-analysis, pertinent studies were identified by searching the PubMed and EMBASE databases through January 13, 2012. Study-specific results were combined using a random-effects model.

Results:

During 10.2 years of follow-up, we ascertained 1,995 incident stroke cases, including 1,511 cerebral infarctions, 321 hemorrhagic strokes, and 163 unspecified strokes. High chocolate consumption was associated with a lower risk of stroke. The multivariable relative risk of stroke comparing the highest quartile of chocolate consumption (median 62.9 g/week) with the lowest quartile (median 0 g/week) was 0.83 (95 % CI 0.70–0.99). The association did not differ by stroke subtypes. In a meta-analysis of 5 studies, with a total of 4,260 stroke cases, the overall relative risk of stroke for the highest vs lowest category of chocolate consumption was 0.81 (95% CI 0.73–0.90), without heterogeneity among studies (p = 0.47).

Conclusion:

These findings suggest that moderate chocolate consumption may lower the risk of stroke.

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Supplementary Material

File (chocolate_consumption_final.pdf)
File (larson.pdf)

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Letters to the Editor
5 September 2012
Acute effect of chocolate ingestion on the cerebral vasculature
Matthew R Walters, Professor of Clinical Pharmacology
Catherine Williamson, Glasgow, UK; Kathryn Lunn, Glasgow, UK; Alison Munteanu, Glasgow, UK

Larsson et al. investigated the association between chocolate consumption and risk of stroke in men, concluding that moderate chocolate consumption may lower the risk of stroke. [1] We performed a prospective mechanistic study that may suggest a potential mechanism for this observation. We investigated the acute effects of a bar (100g) of dark or milk chocolate upon cerebrovascular reactivity in healthy volunteers. The flavanol content of the dark and milk chocolate was 104mg and 32mg of epicatechin respectively. Using a randomized double-blind crossover design, cerebral vasomotor reactivity was measured by Transcranial Doppler ultrasound and calculated using breath-hold index (BHI). Twenty-four fasted, healthy volunteers on no regular medication (f=12, m=12, mean age 23.2 years [SD 3.29]) attended twice, each study visit at least 24 hours apart. Chocolate caused a significant change in BHI by -0.06 units 90 minutes after chocolate ingestion (BHI pre 1.3 [SD 0.16]; BHI post 1.24 [SD 0.14]; p=0.015, n=48). Dark chocolate caused a significant reduction in BHI from baseline by -0.07 units (SD 0.17 p=0.05 n=24) though the change in BHI between dark and milk chocolate was not significant (BHI dark -0.07 [SD 0.17]; BHI milk -0.04 [SD 0.13]; p=0.431, n=24). No differences in blood sugar, heart rate or blood pressure were apparent between groups. Acute ingestion of chocolate was associated with a measurable change in cerebral vasomotor reactivity. Regular consumption of cocoa polyphenols has been shown to reduce the risk of stroke, and antioxidant, antiplatelet, anti-inflammatory effects, together with effects on lipid profile have all been proposed as potential mediators of the effect. [2] Our data suggest that chocolate consumption is associated with an acute change in cerebral vasomotor reactivity, independent of metabolic and hemodynamic parameters. This acute effect may contribute to the observed relationship between long-term chocolate consumption and stroke risk, and is worthy of further investigation.

1. Larsson SC, Virtamo J, Wolk A. Chocolate consumption and risk of stroke: A prospective cohort of men and meta-analysis Neurology 2012; 0: WNL.0b013e31826aacfav1

For disclosures, contact the editorial office.

Information & Authors

Information

Published In

Neurology®
Volume 79Number 12September 18, 2012
Pages: 1223-1229
PubMed: 22933736

Publication History

Received: February 2, 2012
Accepted: May 1, 2012
Published online: August 29, 2012
Published in print: September 18, 2012

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Authors

Affiliations & Disclosures

Susanna C. Larsson, PhD
From the Division of Nutritional Epidemiology (S.C.L., A.W.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; and Department of Chronic Disease Prevention (J.V.), National Institute for Health and Welfare, Helsinki, Finland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
I have received a Research Fellow grant from Karolinska Institutet.
Research Support, Foundations and Societies:
1.
This study was supported by a research grant from the Swedish Council for Working Life and Social Research (FAS).
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Jarmo Virtamo, MD
From the Division of Nutritional Epidemiology (S.C.L., A.W.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; and Department of Chronic Disease Prevention (J.V.), National Institute for Health and Welfare, Helsinki, Finland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Alicja Wolk, DMSc
From the Division of Nutritional Epidemiology (S.C.L., A.W.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; and Department of Chronic Disease Prevention (J.V.), National Institute for Health and Welfare, Helsinki, Finland.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence & reprint requests to Dr. Larsson: [email protected]
Study funding: Supported by research grants from the Swedish Council for Working Life and Social Research (FAS) and the Swedish Research Council/Committee for Infrastructure and by a Research Fellow grant from Karolinska Institutet (to Dr. Larsson). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the article.

Author Contributions

Study concept and design (S.C.L., A.W.), data collection (A.W.), statistical analyses (S.C.L.), manuscript writing (S.C.L.), interpretation of results (S.C.L., J.V., A.W.), and critical revision of manuscript (S.C.L., J.V., A.W.). S.C.L. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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