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June 3, 2008
Cocoa May Stave Off Cardiovascular Disease in Type 2 Diabetes

For type 2 diabetics, topping off standard medications by drinking flavanol-rich cocoa thee times a day may improve endothelial function and reduce cardiovascular risk, according to a small randomized study.

Those who had cocoa three times daily for 30 days had a 30% improvement in flow-mediated dilation of the brachial artery, Malte Kelm, M.D., of University Hospital Aachen, and colleagues reported in the June 3 issue of the Journal of the American College of Cardiology. The cocoa was made from an instant cocoa beverage powder.

"Our study clearly establishes improvements of endothelial function after regular consumption of flavanol-containing cocoa in patients with type 2 diabetes," the researchers said, "highlighting the potential of flavanol-containing diets, and underscoring the potential healthcare benefit for reducing the risk of cardiovascular events in diabetic patients."
However, these results should not, Dr. Kelm said in a statement, be used to encourage diabetics to eat more chocolate.
"Patients with type 2 diabetes can certainly find ways to fit chocolate into a healthy lifestyle, but this study is not about chocolate, and it's not about urging those with diabetes to eat more chocolate," he said. "While more research is needed, our results demonstrate that dietary flavanols might have an important impact as part of a healthy diet in the prevention of cardiovascular complications in diabetic patients."
The researchers noted that the degree of the reversal of endothelial dysfunction was similar to that found in other studies of diabetics with exercise, statins, ACE inhibitors, pioglitazone, and insulin. In addition nitroglycerin-mediated dilation was not affected by the consumption of the flavanols.
The mechanism by which flavanols influenced flow-mediated dilation was not identified in this study but it may be related to the production of nitric oxide, according to the researchers.
"Flow-mediated dilation of the brachial artery is almost entirely [nitric oxide] synthase dependent, & correlates with endothelial function of most conduit arteries, and can, therefore, be used as a surrogate for systemic [nitric oxide] synthesis," the researchers said.
A previous study estimated that the average daily intake of flavanols in the United States was 20 to 100 mg, far below the levels used in the current study.
Previous studies have linked foods that have high concentrations of flavanoids, a group of plant-derived chemicals that includes flavanols, with a reduced cardiovascular disease and mortality risk. Fruits, vegetables, tea, red wine, and cocoa contain flavanols. These findings extend previous findings of the cardiovascular benefits of flavanols to diabetics.
However, although endothelial function has been shown to predict future cardiovascular events, randomized, large-scale clinical trials assessing relevant clinical outcomes are necessary before any recommendations are made regarding dietary supplementation with flavanol-rich cocoa.

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