Advertisement

Chocolate Consumption and Risk of Atrial Fibrillation (from the Physicians' Health Study)

  • Owais Khawaja
    Correspondence
    Corresponding author: Tel: (248) 881-5528; fax: (617) 525-7739.
    Affiliations
    Department of Cardiology, Mercy St. Vincent Medical Center, Toledo, Ohio
    Search for articles by this author
  • Andrew B. Petrone
    Affiliations
    Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Yousuf Kanjwal
    Affiliations
    Department of Cardiology, Mercy St. Vincent Medical Center, Toledo, Ohio
    Search for articles by this author
  • John M. Gaziano
    Affiliations
    Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

    Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston Veterans Affairs Healthcare System, Boston, Massachusetts

    Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

    Geriatric Research, Education, and Clinical Center (GRECC), Boston Veterans Affairs Healthcare System, Boston, Massachusetts
    Search for articles by this author
  • Luc Djoussé
    Affiliations
    Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

    Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston Veterans Affairs Healthcare System, Boston, Massachusetts

    Geriatric Research, Education, and Clinical Center (GRECC), Boston Veterans Affairs Healthcare System, Boston, Massachusetts
    Search for articles by this author
      Chocolate consumption has been shown to protect against various cardiovascular end points; however, little is known about the association between chocolate consumption and incident atrial fibrillation (AF). Therefore, we prospectively examined the association between chocolate consumption and incident AF in a cohort of 18,819 US male physicians. Chocolate consumption was ascertained from 1999 to 2002 through a self-administered food frequency questionnaire. Incident AF was ascertained through yearly follow-up questionnaires. Cox regression was used to estimate relative risks of AF. The average age at baseline was 66 years (±9.1). During a mean follow-up of 9.0 years (±3.0), 2,092 cases of AF occurred. Using <1 per month of chocolate consumption as the reference group, multivariable adjusted hazard ratios (95% confidence interval) for AF were 1.04 (0.93 to 1.18), 1.10 (0.96 to 1.25), 1.14 (0.99 to 1.31), and 1.05 (0.89 to 1.25) for chocolate intake of 1 to 3 per month and 1, 2 to 4, and ≥5 per week (p for trend 0.25), respectively. In a secondary analysis, there was no evidence of effect modification by adiposity (p interaction = 0.71) or age (p interaction = 0.26). In conclusion, our data did not support an association between chocolate consumption and risk of AF in US male physicians.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fuster V.
        • Rydén L.E.
        • Cannom D.S.
        • Crijns H.J.
        • Curtis A.B.
        • Ellenbogen K.A.
        • Halperin J.L.
        • Kay G.N.
        • Le Huezey J.Y.
        • Lowe J.E.
        • Olsson S.B.
        • Prystowsky E.N.
        • Tamargo J.L.
        • Wann L.S.
        • Smith Jr., S.C.
        • Priori S.G.
        • Estes III, N.A.
        • Ezekowitz M.D.
        • Jackman W.M.
        • January C.T.
        • Lowe J.E.
        • Page R.L.
        • Slotwiner D.J.
        • Stevenson W.G.
        • Tracy C.M.
        • Jacobs A.K.
        • Anderson J.L.
        • Albert N.
        • Buller C.E.
        • Creager M.A.
        • Ettinger S.M.
        • Guyton R.A.
        • Halperin J.L.
        • Hochman J.S.
        • Kushner F.G.
        • Ohman E.M.
        • Stevenson W.G.
        • Tarkington L.G.
        • Yancy C.W.
        2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation.
        Circulation. 2011; 123: e269-e367
        • Psaty B.M.
        • Manolio T.A.
        • Kuller L.H.
        • Kronmal R.A.
        • Cushman M.
        • Fried L.P.
        • White R.
        • Furberg C.D.
        • Rautaharju P.M.
        Incidence of and risk factors for atrial fibrillation in older adults.
        Circulation. 1997; 96: 2455-2461
        • Krahn A.D.
        • Manfreda J.
        • Tate R.B.
        • Mathewson F.A.
        • Cuddy T.E.
        The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study.
        Am J Med. 1995; 98: 476-484
        • Go A.S.
        • Hylek E.M.
        • Phillips K.A.
        • Chang Y.
        • Henault L.E.
        • Selby J.V.
        • Singer D.E.
        Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.
        JAMA. 2001; 285: 2370-2375
        • Feinberg W.M.
        • Blackshear J.L.
        • Laupacis A.
        • Kronmal R.
        • Hart R.G.
        Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications.
        Arch Intern Med. 1995; 155: 469-473
        • Furberg C.D.
        • Psaty B.
        • Manolio T.A.
        • Gardin J.M.
        • Smith V.E.
        • Rautaharju P.M.
        Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study).
        Am J Cardiol. 1994; 74: 236-241
        • Mozaffarian D.
        • Furberg C.D.
        • Psaty B.M.
        • Siscovick D.
        Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study.
        Circulation. 2008; 118: 800-807
        • Frost L.
        • Hune L.J.
        • Vestergaard P.
        Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study.
        Am J Med. 2005; 118: 489-495
        • Aviles R.J.
        • Martin D.O.
        • Apperson-Hansen C.
        • Houghtaling P.L.
        • Rautaharju P.
        • Kronmal R.A.
        • Tracy R.P.
        • Van Wagoner D.R.
        • Psaty B.M.
        • Lauer M.S.
        • Chung M.K.
        Inflammation as a risk factor for atrial fibrillation.
        Circulation. 2003; 108: 3006-3010
        • Hodgkinson J.A.
        • Taylor C.J.
        • Hobbs F.D.
        Predictors of incident atrial fibrillation and influence of medications: a retrospective case-control study.
        Br J Gen Pract. 2011; 61: e353-e361
        • Dublin S.
        • Glazer N.L.
        • Smith N.L.
        • Psaty B.M.
        • Lumley T.
        • Wiggins K.L.
        • Page R.L.
        • Heckbert S.R.
        Diabetes mellitus, glycemic control, and risk of atrial fibrillation.
        J Gen Intern Med. 2010; 25: 853-858
        • Watanabe H.
        • Tanabe N.
        • Yagihara N.
        • Watanabe T.
        • Aizawa Y.
        • Kodama M.
        Association between lipid profile and risk of atrial fibrillation.
        Circ J. 2011; 75: 2767-2774
        • Hu F.B.
        • Willett W.C.
        Optimal diets for prevention of coronary heart disease.
        JAMA. 2002; 288: 2569-2578
        • Korre M.
        • Tsoukas M.A.
        • Frantzeskou E.
        • Yang J.
        • Kales S.N.
        Mediterranean diet and workplace health promotion.
        Curr Cardiovasc Risk Rep. 2014; 8: 416
        • Ried K.
        • Sullivan T.
        • Fakler P.
        • Frank O.R.
        • Stocks N.P.
        Does chocolate reduce blood pressure? A meta-analysis.
        BMC Med. 2010; 8: 39
        • Grassi D.
        • Desideri G.
        • Necozione S.
        • Lippi C.
        • Casale R.
        • Properzi G.
        • Blumberg J.B.
        • Ferri C.
        Blood pressure is reduced and insulin sensitivity increased in glucose-intolerant, hypertensive subjects after 15 days of consuming high-polyphenol dark chocolate.
        J Nutr. 2008; 138: 1671-1676
        • Greenberg J.A.
        Chocolate intake and diabetes risk.
        Clin Nutr. 2015; 34: 129-133
        • Matsumoto C.
        • Petrone A.B.
        • Sesso H.D.
        • Gaziano J.M.
        • Djoussé L.
        Chocolate consumption and risk of diabetes mellitus in the Physicians' Health Study.
        Am J Clin Nutr. 2015; 101: 362-367
        • Djoussé L.
        • Hopkins P.N.
        • North K.E.
        • Pankow J.S.
        • Arnett D.K.
        • Ellison R.C.
        Chocolate consumption is inversely associated with prevalent coronary heart disease: the National Heart, Lung, and Blood Institute Family Heart Study.
        Clin Nutr. 2011; 30: 182-187
        • Lewis J.R.
        • Prince R.
        • Zhu K.
        • Devine A.
        • Thompson P.L.
        • Hodgson J.M.
        Habitual chocolate intake and vascular disease: a prospective study of clinical outcomes in older women.
        Arch Intern Med. 2010; 170: 1857-1858
        • Petrone A.B.
        • Gaziano J.M.
        • Djoussé L.
        Chocolate consumption and risk of heart failure in the Physicians' Health Study.
        Eur J Heart Fail. 2014; 16: 1372-1376
        • Christen W.G.
        • Gaziano J.M.
        • Hennekens C.H.
        Design of Physicians' Health Study II—a randomized trial of beta-carotene, vitamins E and C, and multivitamins, in prevention of cancer, cardiovascular disease, and eye disease, and review of results of completed trials.
        Ann Epidemiol. 2000; 10: 125-134
        • Steering Committee of the Physicians' Health Study Research Group
        Final report on the aspirin component of the ongoing Physicians' Health Study.
        N Engl J Med. 1989; 321: 129-135
        • Willett W.C.
        • Sampson L.
        • Stampfer M.J.
        • Rosner B.
        • Bain C.
        • Witschi J.
        • Hennekens C.H.
        • Speizer F.E.
        Reproducibility and validity of a semiquantitative food frequency questionnaire.
        Am J Epidemiol. 1985; 122: 51-65
        • Rimm E.B.
        • Giovannucci E.L.
        • Stampfer M.J.
        • Colditz G.A.
        • Litin L.B.
        • Willett W.C.
        Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals.
        Am J Epidemiol. 1992; 135: 1114-1126
        • Aizer A.
        • Gaziano J.M.
        • Cook N.R.
        • Manson J.E.
        • Buring J.E.
        • Albert C.M.
        Relation of vigorous exercise to risk of atrial fibrillation.
        Am J Cardiol. 2009; 103: 1572-1577
        • Djoussé L.
        • Driver J.A.
        • Gaziano J.M.
        Relation between modifiable lifestyle factors and lifetime risk of heart failure.
        JAMA. 2009; 302: 394-400
        • Cheng M.
        • Hu Z.
        • Lu X.
        • Huang J.
        • Gu D.
        Caffeine intake and atrial fibrillation incidence: dose response meta-analysis of prospective cohort studies.
        Can J Cardiol. 2014; 30: 48-54