James A Greenberg1, JoAnn E Manson2, Marian L Neuhouser3, Lesley Tinker3, Charles Eaton4, Karen C Johnson5, James M Shikany6. 1. Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn, NY. 2. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 3. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA. 4. Department of Family Medicine and Epidemiology, Alpert Medical School, Brown University, Providence, RI. 5. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN. 6. Department of Medicine, Division of Preventive Medicine, University of Alabama, Birmingham, AL.
Abstract
Background: Three recent meta-analyses found significant prospective inverse associations between chocolate intake and cardiovascular disease risk. Evidence from these meta-analyses suggests that such inverse associations may only apply to elderly individuals or those with pre-existing major chronic disease. Objective: We assessed the association between habitual chocolate intake and subsequent incident coronary heart disease (CHD) and stroke, and the potential effect of modification by age. Design: We conducted multivariable Cox regression analyses using data from 83,310 postmenopausal women free of baseline pre-existing major chronic disease in the prospective Women's Health Initiative cohort. Chocolate intake was assessed using a food-frequency questionnaire. Physician-adjudicated events or deaths were ascertained up to 30 September 2013. Results: After exclusions, there were 3246 CHD and 2624 stroke events or deaths, representing incidence rates of 3.9% and 3.2% during 1,098,091 and 1,101,022 person-years (13.4 y), respectively. We found no association between consumption of chocolate and risk of CHD (P for linear trend = 0.94) or stroke (P = 0.24). The results for CHD and stroke combined were similar (P = 0.30), but were significantly modified by age (P for interaction = 0.02). For women age <65 y at baseline, those who ate 1 oz (28.35 g) of chocolate <1/mo, 1 to <1.5/mo, 1.5 to <3.5/mo, 3.5/mo to <3/wk, and ≥3/wk had HRs (95% CIs) of 1.00 (referent), 1.17 (1.00, 1.36), 1.05 (0.90, 1.22), 1.09 (0.94, 1.25), and 1.27 (1.09, 1.49), respectively (P for linear trend = 0.005). No association was apparent for older women. Conclusion: We observed no association between chocolate intake and risk of CHD, stroke, or both combined in participants free of pre-existing major chronic disease. The relation for both combined was modified by age, with a significant positive linear trend and an increased risk in the highest quintile of chocolate consumption among women age <65 y. This trial was registered at clinicaltrials.gov as NCT03453073.
Background: Three recent meta-analyses found significant prospective inverse associations between chocolate intake and cardiovascular disease risk. Evidence from these meta-analyses suggests that such inverse associations may only apply to elderly individuals or those with pre-existing major chronic disease. Objective: We assessed the association between habitual chocolate intake and subsequent incident coronary heart disease (CHD) and stroke, and the potential effect of modification by age. Design: We conducted multivariable Cox regression analyses using data from 83,310 postmenopausal women free of baseline pre-existing major chronic disease in the prospective Women's Health Initiative cohort. Chocolate intake was assessed using a food-frequency questionnaire. Physician-adjudicated events or deaths were ascertained up to 30 September 2013. Results: After exclusions, there were 3246 CHD and 2624 stroke events or deaths, representing incidence rates of 3.9% and 3.2% during 1,098,091 and 1,101,022 person-years (13.4 y), respectively. We found no association between consumption of chocolate and risk of CHD (P for linear trend = 0.94) or stroke (P = 0.24). The results for CHD and stroke combined were similar (P = 0.30), but were significantly modified by age (P for interaction = 0.02). For women age <65 y at baseline, those who ate 1 oz (28.35 g) of chocolate <1/mo, 1 to <1.5/mo, 1.5 to <3.5/mo, 3.5/mo to <3/wk, and ≥3/wk had HRs (95% CIs) of 1.00 (referent), 1.17 (1.00, 1.36), 1.05 (0.90, 1.22), 1.09 (0.94, 1.25), and 1.27 (1.09, 1.49), respectively (P for linear trend = 0.005). No association was apparent for older women. Conclusion: We observed no association between chocolate intake and risk of CHD, stroke, or both combined in participants free of pre-existing major chronic disease. The relation for both combined was modified by age, with a significant positive linear trend and an increased risk in the highest quintile of chocolate consumption among women age <65 y. This trial was registered at clinicaltrials.gov as NCT03453073.
Authors: J David Curb; Anne McTiernan; Susan R Heckbert; Charles Kooperberg; Janet Stanford; Michael Nevitt; Karen C Johnson; Lori Proulx-Burns; Lisa Pastore; Michael Criqui; Sandra Daugherty Journal: Ann Epidemiol Date: 2003-10 Impact factor: 3.797
Authors: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: Ann Intern Med Date: 2007-10-16 Impact factor: 25.391
Authors: Stephanie E Chiuve; Teresa T Fung; Eric B Rimm; Frank B Hu; Marjorie L McCullough; Molin Wang; Meir J Stampfer; Walter C Willett Journal: J Nutr Date: 2012-04-18 Impact factor: 4.798
Authors: Ralph B D'Agostino; Ramachandran S Vasan; Michael J Pencina; Philip A Wolf; Mark Cobain; Joseph M Massaro; William B Kannel Journal: Circulation Date: 2008-01-22 Impact factor: 29.690
Authors: Xiaochen Lin; Isabel Zhang; Alina Li; JoAnn E Manson; Howard D Sesso; Lu Wang; Simin Liu Journal: J Nutr Date: 2016-09-28 Impact factor: 4.798
Authors: Yuk-Lam Ho; Xuan-Mai T Nguyen; Joseph Q Yan; Jason L Vassy; David R Gagnon; J Michael Gaziano; Peter Wf Wilson; Kelly Cho; Luc Djoussé Journal: Am J Clin Nutr Date: 2021-03-01 Impact factor: 8.472
Authors: Howard D Sesso; JoAnn E Manson; Aaron K Aragaki; Pamela M Rist; Lisa G Johnson; Georgina Friedenberg; Trisha Copeland; Allison Clar; Samia Mora; M Vinayaga Moorthy; Ara Sarkissian; William R Carrick; Garnet L Anderson Journal: Am J Clin Nutr Date: 2022-06-07 Impact factor: 8.472
Authors: Maria Teresa Montagna; Giusy Diella; Francesco Triggiano; Giusy Rita Caponio; Osvalda De Giglio; Giuseppina Caggiano; Agostino Di Ciaula; Piero Portincasa Journal: Int J Environ Res Public Health Date: 2019-12-06 Impact factor: 3.390