Evidence map›Paper›PMID 26076934›Full record

SynthesisHeart (British Cardiac Society)2015

Habitual chocolate consumption and risk of cardiovascular disease among healthy men and women.

Chun Shing Kwok, S Matthijs Boekholdt, Marleen A H Lentjes, Yoon K Loke, Robert N Luben, Jessica K Yeong, Nicholas J Wareham, Phyo K Myint, Kay-Tee Khaw

Erratum issuedAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Heart (British Cardiac Society), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 32 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

32 citing papers in PubMed, 8 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Chun Shing KwokEpidemiology Group, Division of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, UK Cardiovascular Institute, University of Manchester, Manchester, UK.
S Matthijs BoekholdtDepartment of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
Marleen A H LentjesDepartment of Public Health & Primary Care, University of Cambridge, Cambridge, UK.
Yoon K LokeDepartment of Public Health & Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK.
Robert N LubenDepartment of Public Health & Primary Care, University of Cambridge, Cambridge, UK.
Jessica K YeongLancashire Teaching Hospital NHS Foundation Trust, Preston, UK.
Nicholas J WarehamMedical Research Council Epidemiology Unit, Cambridge, UK.
Phyo K MyintEpidemiology Group, Division of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, UK.ORCID http://orcid.org/0000-0003-3852-6158
Kay-Tee KhawDepartment of Public Health & Primary Care, University of Cambridge, Cambridge, UK.

Funding

Cancer Research UKMedical Research Council G0401527Medical Research Council G1000143Medical Research Council MC_U106179471Medical Research Council MC_UU_12015/1
6 · The paper itself

Abstract

objectiveTo examine the association between chocolate intake and the risk of future cardiovascular events.

methodsWe conducted a prospective study using data from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Habitual chocolate intake was quantified using the baseline food frequency questionnaire (1993-1997) and cardiovascular end points were ascertained up to March 2008. A systematic review was performed to evaluate chocolate consumption and cardiovascular outcomes.

resultsA total of 20,951 men and women were included in EPIC-Norfolk analysis (mean follow-up 11.3±2.8 years, median 11.9 years). The percentage of participants with coronary heart disease (CHD) in the highest and lowest quintile of chocolate consumption was 9.7% and 13.8%, and the respective rates for stroke were 3.1% and 5.4%. The multivariate-adjusted HR for CHD was 0.88 (95% CI 0.77 to 1.01) for those in the top quintile of chocolate consumption (16-99 g/day) versus non-consumers of chocolate intake. The corresponding HR for stroke and cardiovascular disease (cardiovascular disease defined by the sum of CHD and stroke) were 0.77 (95% CI 0.62 to 0.97) and 0.86 (95% CI 0.76 to 0.97). The propensity score matched estimates showed a similar trend. A total of nine studies with 157,809 participants were included in the meta-analysis. Higher compared to lower chocolate consumption was associated with significantly lower CHD risk (five studies; pooled RR 0.71, 95% CI 0.56 to 0.92), stroke (five studies; pooled RR 0.79, 95% CI 0.70 to 0.87), composite cardiovascular adverse outcome (two studies; pooled RR 0.75, 95% CI 0.54 to 1.05), and cardiovascular mortality (three studies; pooled RR 0.55, 95% CI 0.36 to 0.83).

conclusionsCumulative evidence suggests that higher chocolate intake is associated with a lower risk of future cardiovascular events, although residual confounding cannot be excluded. There does not appear to be any evidence to say that chocolate should be avoided in those who are concerned about cardiovascular risk.

Indexed as

CacaoCandyCoronary DiseaseStrokeEatingFeeding BehaviorFemaleHumansMaleMiddle AgedPatient Outcome AssessmentPreventive Health ServicesProspective StudiesRisk AssessmentRisk FactorsSurveys and Questionnaires

Identifiers

PMID26076934
PMCPMC6284792

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.