Of the 4,970 participants used for analysis, 2,258 were men and 2,712 were women. The mean age (SD) was 52.0 (13.7) years and CHD prevalence was 10.9%. presents baseline characteristics according to chocolate intake. Frequent chocolate consumption was associated with younger age, higher body mass and energy intake and lower HDL; lower frequency of fruit and vegetable consumption, wine consumption, multivitamin use; higher consumption of non-chocolate candy, saturated fat, and dietary cholesterol. Age-, sex-, and energy-adjusted means of dietary cholesterol, saturated fat, and polyunsaturated fat were 0.21 vs. 0.23 g/d, 0.24 vs. 0.25 g/d, and 9.2 vs. 9.0 g/d when comparing subjects with prevalent CHD vs. those without CHD, respectively.
Characteristics among 4,970 participants of the NHLBI Family Heart Study by chocolate intake
There was evidence for an inverse association between frequency of chocolate consumption and prevalent CHD in crude and adjusted models (). In the fully adjusted model, consumption of 5+/week was associated with 57% lower prevalent CHD compared with subjects who did not consume chocolate (). Exclusion of subjects with prevalent diabetes and those who were on weight loss diet made the association stronger: from the lowest to the highest category of chocolate, ORs were 1.0, 0.98, 0.68, and 0.38 (p for trend 0.0002, , Model 2). Similar association was observed in subjects who were 60 years of age or younger and those above the age of 60 (). Furthermore, similar associations were seen among smokers and non-smokers (e.g., for the highest category of chocolate intake, the ORs were 0.44 for smokers and 0.43 for non-smokers). Including a composite variable for consumption of butter, eggs, hot dogs, and hamburgers resulted in a slight attenuation of the findings (data not shown). Similar results were seen after additional adjustment for myristic acid (C14.0) – a saturated fatty acid found in low concentration in chocolate. In addition, 5-year age categories to control residual confounding by age did not alter the results (p for trend 0.0002). Finally, restriction to Caucasians did not alter the findings: from the lowest to the highest category of chocolate consumption, multivariable adjusted odds ratios (95% CI) were 1.0 (reference), 1.03 (0.76-1.40), 0.75 (0.56-1.01), and 0.44 (0.28-0.70), respectively (p for trend 0.0002). Adjustment for potential intermediate factors such as lipids, blood pressure, diabetes, measures of adiposity led to a minimal attenuation [OR: 1.0 (ref), 1.05 (0.77-1.43), 0.75 (0.56-1.01), and 0.43 (0.27-0.68) from the lowest to the highest category of chocolate, p for trend 0.0002]. There was no association between chocolate consumption and blood pressure: from the lowest to the highest category of chocolate consumption, adjusted odds ratios for hypertension were 1.0 (reference), 0.99 (0.77-1.26), 0.96 (0.75-1.23), and 1.11 (0.81-1.53), respectively (p for trend 0.72).
Prevalence odds ratios (95% confidence intervals) of coronary heart disease according to chocolate consumption in 4,970 participants in the NHLBI Family Heart Study*
Prevalence odds ratios (95% confidence intervals) of coronary heart disease according to chocolate consumption in 4,366 subjects free of diabetes mellitus and subjects who were on weight loss diet*
Prevalence odds ratios (95% confidence intervals) of coronary heart disease according to chocolate consumption and age in 4,970 subjects in the NHLBI Family Heart Study*
In contrast, non-chocolate candy consumption was suggestive of an increased prevalence of CHD. Multivariable adjusted odds ratios (95% CI) were 1.0 (ref), 0.96 (0.72-1.27), 1.05 (0.79-1.39), and 1.49 (0.96-2.32) for non-chocolate candy consumption of 0, 1-3/month, 1-4/week, and 5+/week, respectively, adjusting for age, sex, exercise, energy, linolenic acid, education, risk group, chocolate consumption, alcohol, smoking, and fruit and vegetables.