Chocolate consumption and risk of stroke among men and women: A large population-based, prospective cohort study

Atherosclerosis. 2017 May:260:8-12. doi: 10.1016/j.atherosclerosis.2017.03.004. Epub 2017 Mar 4.


Background and aims: Chocolate consumption may have a beneficial effect on cardiovascular health, but evidence from prospective cohort studies is still limited. We aimed to examine the prospective associations between chocolate consumption and risk of stroke among men and women in a large population-based cohort.

Methods: A total of 38,182 men and 46,415 women aged 44-76 years, and free of cardiovascular disease, diabetes, and cancer at baseline in 1995 and 1998, were followed up until the end of 2009 and 2010, respectively. We obtained data on chocolate consumption for each participant using a self-administrated food frequency questionnaire that included 138 food and beverage items. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of stroke in relation to chocolate consumption.

Results: During a median follow-up of 12.9 years, we identified 3558 incident strokes cases (2146 cerebral infarctions and 1396 hemorrhagic strokes). After adjustment for age, body mass index, life styles, dietary intakes, and other risk factors, chocolate consumption was associated with a significant lower risk of stroke in women (HR = 0.84; 95% CI, 0.71-0.99). However, the association in men was not significant (HR = 0.94; 95% CI, 0.80-1.10). In addition, the association did not vary by stroke subtypes in either men or women.

Conclusions: Findings from this large Japanese cohort supported a significant inverse association between chocolate consumption and risk of developing stroke in women. However, residual confounding could not be excluded as an alternative explanation for our findings.

Keywords: Chocolate; Prospective cohort study; Stroke.

Publication types

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

MeSH terms

  • Adult
  • Aged
  • Chocolate*
  • Disease Progression
  • Feeding Behavior*
  • Female
  • Follow-Up Studies
  • Forecasting*
  • Humans
  • Incidence
  • Japan / epidemiology
  • Life Style
  • Male
  • Middle Aged
  • Population Surveillance
  • Prospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Stroke / epidemiology*
  • Stroke / prevention & control
  • Surveys and Questionnaires
  • Survival Rate / trends