It has been shown that the consumption of cocoa has a positive influence on a 
number of cardiovascular surrogate parameters such as arterial vasodilatation 
and a moderate decrease in blood pressure in humans. In the blood, a decrease in 
platelet aggregation and an increase in angiogenetic progenitor cells was noted. 
Furthermore, anti-inflammatory effects, an amelioration of the lipid profile and 
glucose metabolism was described. An increase of endothelial NO production 
following the ingestion of the antioxidant cocoa flavanols catechin and 
epicatechin seems to be the leading mechanism causing these effects. In animal 
studies of myocardial reperfusion, a decrease in infarct size was noted. In 
several prospective cohort studies from Europe and the United States, a 50 % 
reduction of mortality mostly due to a reduction of myocardial infarction was 
published. Consumption up to about 25 g daily of a flavanol rich dark chocolate 
(ca. 85 % cocoa content) can be recommended for cardiovascular prevention. In 
this moderate dosage, the potentially harmful effects due to weight gain and 
cadmium intake will be minimal. However, controlled randomized trials with well 
defined clinical endpoints are needed to prove the positive effects described so 
far. At this point, in time based on the information described in this article, 
a moderate consumption of flavanol rich cocoa products seems to be effective in 
the prevention of coronary artery disease and myocardial infarction.