Chocolate consumption and mortality following a first acute myocardial infarction: The Stockholm Heart Epidemiology Program – Source: Journal of Internal Medicine, Sep 2009

[Note: previous large population tracking studies have linked dark chocolate consumption to reduced risk of hypertension and cardiovascular disease/heart attack. This 8-year tracking study of first heart attack survivors (excluding diabetics) strongly linked chocolate consumption two or more times weekly to 66% less risk of dying from heart disease.]

Objectives: To assess the long-term effects of chocolate consumption amongst patients with established coronary heart disease.

Design: In a population-based inception cohort study, we followed 1,169 non-diabetic patients hospitalized with a confirmed first acute myocardial infarction (AMI) between 1992 and 1994 in Stockholm County, Sweden, as part of the Stockholm Heart Epidemiology Program.

Participants self-reported usual chocolate consumption over the preceding 12 months with a standardized questionnaire distributed during hospitalization and underwent a health examination 3 months after discharge. Participants were followed for hospitalizations and mortality with national registries for 8 years.


• Chocolate consumption had a strong inverse association with cardiac mortality. [More chocolate, less mortality.]

• When compared with those never eating chocolate, the multivariable-adjusted hazard ratios were 0.73 (95% confidence interval, 0.41–1.31), 0.56 (0.32–0.99) and 0.34 (0.17–0.70) for those consuming chocolate less than once per month, up to once per week and twice or more per week, respectively. [Note: a hazard ratio of 1.0 would indicate no difference between groups. Thus, the ratio of 0.34 would indicate 66% less risk of death from heart disease over the tracking period in the group consuming chocolate twice or more per week versus those consuming no chocolate. Even those eating less chocolate had better odds of survival.]

Chocolate consumption generally had an inverse but weak association with total mortality and nonfatal outcomes.

In contrast, intake of other sweets was not associated with cardiac or total mortality.

Conclusions: Chocolate consumption was associated with lower cardiac mortality in a dose dependent manner in patients free of diabetes surviving their first AMI.

Although our findings support increasing evidence that chocolate is a rich source of beneficial bioactive compounds, confirmation of this strong inverse relationship from other observational studies or large-scale, long-term, controlled randomized trials is needed.

Source: Journal of Internal Medicine, Sep 2009;266(3), 248-257. Janszky I, Mukamal KJ, Ljung R, Ahnve S, Ahlbom A, Hallqvist J. Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Centre for Epidemiology, The National Board of Health and Welfare, Stockholm; Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. [E-mail:]

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