Chocolate consumption and risk of coronary artery disease: the Million Veteran Program

• Authors: Yuk-Lam Ho, VA Boston Healthcare System; X-MT Nguyen, VA Boston Healthcare System; Joseph Q Yan, VA Boston Healthcare System; Jason L Vassy, VA Boston Healthcare System; David R Gagnon, VA Boston Healthcare System; Michael J O'Donnell, VA Boston Healthcare System; JM Gaziano, Atlanta VA Med Ctr; Peter Wilson, Emory University; Kelly Cho, VA Boston Healthcare System; Luc Djoussé, VA Boston Healthcare System
• Journal Title: AMERICAN JOURNAL OF CLINICAL NUTRITION
• Volume: Volume 113, Number 5
• Publisher: OXFORD UNIV PRESS | 2021-03-01, Pages 1137-1144
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1093/ajcn/nqaa427
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Nutrition & Dietetics; coronary artery disease; nutrition; epidemiology; risk factors; incidence rate; cohort study; BLOOD-PRESSURE; CARDIOVASCULAR-DISEASE; DARK CHOCOLATE; HEART-DISEASE; COCOA; RICH; METAANALYSIS; MORTALITY; HEALTH

Abstract

Background: Although previous studies have suggested cocoa products may promote cardiovascular health in the general population, no public data are available from patients receiving care in a national integrated health care system. Objectives: We tested the hypothesis that regular chocolate consumption is associated with a lower risk of coronary artery disease (CAD) events among participants of the Million Veteran Program (MVP). Secondary analysis examined if the main hypothesis was observed among participants with type 2 diabetes. Methods: We analyzed data from MVP participants who completed the food frequency section of the MVP Lifestyle Survey and were free of CAD at the time of survey completion. CAD events during follow-up (International Statistical Classification of Diseases Ninth Revision codes 410 411 and 413 414, and Tenth Revision codes I20 I25 except I25.2) were assessed using electronic health records. We fitted a Cox proportional hazard model to estimate the RR of CAD. Results: Of 188,447 MVP enrollees with survey data, mean ± SD age was 64 ± 12.0 y and 90% were men. For regular chocolate (28.3 g/serving) consumption of <1 serving/mo, 1 3 servings/mo, 1 serving/wk, 2 4 servings/wk, and =5 servings/wk, crude incidence rates (per 1000 person-years) for fatal and nonfatal CAD events or coronary procedures were 20.2, 17.5, 16.7, 17.1, and 16.9, respectively, during a mean follow-up of 3.2 y. After adjusting for age, sex, race, and lifestyle factors, the corresponding HRs (95% CIs) were 1.00 (ref), 0.92 (0.87, 0.96), 0.88 (0.83, 0.93), 0.89 (0.84, 0.95), and 0.89 (0.84, 0.96), respectively (P for linear trend < 0.0001). In a secondary analysis of 47,265 diabetics, we did not observe a decreasing trend in CAD mortality among those who consumed =1 serving of chocolate a month compared with those who consumed <1 serving/mo. Conclusions: Regular chocolate consumption was associated with a lower risk of CAD among veterans, but was not associated with cardiovascular disease risk in veterans with type 2 diabetes.