Chocolate intake and risk of clinically apparent atrial fibrillation: the Danish Diet, Cancer, and Health Study

Abstract

Objective: To evaluate the association between chocolate intake and incident clinically apparent atrial fibrillation or flutter (AF).

Methods: The Danish Diet, Cancer, and Health Study is a large population-based prospective cohort study. The present study is based on 55 502 participants (26 400 men and 29 102 women) aged 50-64 years who had provided information on chocolate intake at baseline. Incident cases of AF were ascertained by linkage with nationwide registries.

Results: During a median of 13.5 years there were 3346 cases of AF. Compared with chocolate intake less than once per month, the rate of AF was lower for people consuming 1-3 servings/month (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.82 to 0.98), 1 serving/week (HR 0.83, 95% CI 0.74 to 0.92), 2-6 servings/week (HR 0.80, 95% CI 0.71 to 0.91) and ≥1 servings/day (HR 0.84, 95% CI 0.65 to 1.09; p-linear trend <0.0001), with similar results for men and women.

Conclusions: Accumulating evidence indicates that moderate chocolate intake may be inversely associated with AF risk, although residual confounding cannot be ruled out.

Figure 1

Multivariable hazard ratios (HR) and 95% confidence intervals (CI) according to frequency of chocolate intake in the Danish Diet, Cancer, and Health Study P-trend is the value for linear component of trend Age was the time scale in the Cox models and we adjusted for total calories, sex, body mass index, systolic blood pressure (mm Hg), total serum cholesterol (continuous), coffee consumption (continuous), alcohol consumption (grams/day), smoking status (never, former, current), years of education beyond elementary school (0, <3, 3 4, >4 years), hypertension (yes/no), diabetes mellitus (yes/no) and cardiovascular disease (yes/no)