BACKGROUND: Accumulating evidence suggests potential preventive effects of 
chocolate/cocoa on the risk of cardio vascular disease (CVD). However, cocoa 
products also contain high levels of sugar and fat, which increase CVD risk 
factors. Even, the identity of the substance in chocolate/cocoa that has a 
favorable effect on CVD and CVD risk factors remains unclear, growing evidence 
from experimental studies suggests that cocoa polyphenols might be a major 
contributor to cardiovascular-protective effects. However, epidemiological 
studies, which are necessary to evaluate an association between the risk of CVD 
and cocoa polyphenol, remain sparse.
METHODS: We will discuss recent evidence regarding the association between cocoa 
polyphenol consumption and the risks of CVD and its risk factors by reviewing 
recent epidemiological studies. We shall also provide some guidance for patient 
counseling and will discuss the public health implications for recommending 
cocoa polyphenol consumption to prevent CVD.
RESULTS: Epidemiological studies evaluating the association between cocoa 
polyphenol itself and the risk of CVD are sparse. However, evidence from limited 
epidemiological studies suggests that cocoa polyphenol consumption may lower the 
risk of CVD.
CONCLUSION: Given the potential adverse effects of the consumption of cocoa 
products with high fat and sugar and the fact that the most appropriate dose of 
cocoa polyphenol for cardio-protective effects has not yet been established, 
health care providers should remain cautious about recommending cocoa/cocoa 
polyphenol consumption to their patients to reduce the risk of CVD, taking the 
characteristics of individual patients into careful consideration.