The cardiovascular benefits of dark chocolate

Vascul Pharmacol. 2015 Aug;71:11-5. doi: 10.1016/j.vph.2015.05.011. Epub 2015 May 27.


Dark chocolate contains many biologically active components, such as catechins, procyanidins and theobromine from cocoa, together with added sucrose and lipids. All of these can directly or indirectly affect the cardiovascular system by multiple mechanisms. Intervention studies on healthy and metabolically-dysfunctional volunteers have suggested that cocoa improves blood pressure, platelet aggregation and endothelial function. The effect of chocolate is more convoluted since the sucrose and lipid may transiently and negatively impact on endothelial function, partly through insulin signalling and nitric oxide bioavailability. However, few studies have attempted to dissect out the role of the individual components and have not explored their possible interactions. For intervention studies, the situation is complex since suitable placebos are often not available, and some benefits may only be observed in individuals showing mild metabolic dysfunction. For chocolate, the effects of some of the components, such as sugar and epicatechin on FMD, may oppose each other, or alternatively in some cases may act together, such as theobromine and epicatechin. Although clearly cocoa provides some cardiovascular benefits according to many human intervention studies, the exact components, their interactions and molecular mechanisms are still under debate.

Keywords: Cocoa; Endothelial dysfunction; Flavonoid; Nitric oxide; Theobromine.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Blood Pressure / drug effects
  • Blood Pressure / physiology
  • Cacao / metabolism*
  • Cardiovascular Diseases / metabolism*
  • Cardiovascular Diseases / prevention & control*
  • Catechin / isolation & purification
  • Catechin / pharmacology
  • Catechin / therapeutic use
  • Endothelium, Vascular / drug effects
  • Endothelium, Vascular / metabolism
  • Flavonoids / isolation & purification
  • Flavonoids / pharmacology
  • Flavonoids / therapeutic use
  • Humans
  • Theobromine / isolation & purification
  • Theobromine / pharmacology
  • Theobromine / therapeutic use


  • Flavonoids
  • Catechin
  • Theobromine