Rapid Review Quiz: Chocolate and Health 

Helmi L. Lutsep, MD; Yasmine S. Ali, MD; Bradley Schwartz, DO


January 30, 2023

Results of a large, randomized trial, the COcoa Supplement and Multivitamin Outcomes Study (COSMOS), found that 3.6 years of cocoa extract (500 mg flavanols/d, including 80 mg (–)-epicatechin) was associated with a 10% lower rate of total cardiovascular events in older adults, including myocardial infarction, stroke, revascularization, and unstable angina, although this reduction was not statistically significant compared with placebo. However, the supplementation did cause a statistically significant 27% reduction in cardiovascular disease death. Analyses of participants who regularly adhered to supplementation vs those who regularly adhered to placebo found a significant 16% reduction in major cardiovascular events compared with placebo.

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