A full report of the PURE study was published in the August 26 online Lancet.
Regular Consumption of Chocolate Could Cut Cardiovascular Risk
A number of recent studies have shown that eating chocolate has a positive influence on human health due to its antioxidant and anti-inflammatory properties. This includes reducing blood pressure and improving insulin sensitivity.
However, the evidence about how eating chocolate affects your heart still remains unclear. Oscar Franco, MD, DSc, PhD, and colleagues from the University of Cambridge, United Kingdom, carried out a large-scale review of the existing evidence to evaluate the effects of eating chocolate on cardiovascular events such as heart attack and stroke.
They analyzed the results of seven studies, involving more than 100,000 participants, on this topic. Differences in study design and quality were taken into account to minimize bias.
Five studies reported a beneficial link between higher levels of chocolate consumption and the risk of cardiovascular events. The highest levels of chocolate consumption were associated with a 37% reduction in cardiovascular disease and a 29% reduction in stroke, compared with lowest levels.
The studies did not differentiate between dark or milk chocolate and included consumption of chocolate bars, drinks, biscuits, and desserts.
The authors said the findings need to be interpreted with caution, in particular because commercially available chocolate is very calorific (about 500 calories for every 100 grams) and eating too much of it could in itself lead to weight gain, risk of diabetes, and heart disease.
The investigators concluded that, given chocolate’s health benefits, initiatives to reduce the fat and sugar content in chocolate products, without affecting the taste sensation, should be explored.
Smoking Cessation Program Is Effective in Reducing Cardiovascular Risk
A nurse-led, family-centered preventive cardiology program for smokers at high risk for cardiovascular disease and their partners, with intensive smoking cessation support and optional use of varenicline in general practices, can improve smoking cessation in this group of smokers in routine clinical practice.
Such a program reduces total cardiovascular risk for both vascular patients and patients without symptoms but at high risk of developing a heart attack or stroke. These are the conclusions of David Wood, MD, and colleagues from Imperial College London who conducted the study in four European countries between January 2010 and July 2011.
Following smoking cessation, there is a rapid decline in risk of cardiovascular disease. In those with cardiovascular disease, the risk falls within two to three years to the level of those with cardiovascular disease who never smoked. In asymptomatic people, up to 10 years are needed to reach the risk level of a person who never smoked. On average, smokers die 10 years younger than nonsmokers. Stopping at 50 cuts the risk in half, but if a smoker stops before age 30, the hazard may be eliminated completely. Stopping at age 60, 50, 40, or 30 results in gains of three, six, nine, or 10 years of life expectancy, respectively. There is also a 36% risk reduction of all-cause mortality in those who stop smoking following myocardial infarction. After one year, the excess risk of coronary heart disease caused by smoking is reduced by half. After 15 years, the risk is similar to that of a nonsmoker.
In addition, a more comprehensive lifestyle intervention, risk factor management, and cardioprotective drugs can further reduce morbidity and mortality and increase life expectancy in these patients. However, the most recent EUROASPIRE survey showed that smoking cessation support in routine clinical practice is inadequate.
More than half of coronary patients who were smoking at the time of their event were still smoking one year later. In persons at high risk of developing cardiovascular disease identified in general practice, nearly 90% were still smoking after they had been started on therapies to reduce their cardiovascular risk. The EUROASPIRE survey also showed that, although a large proportion of patients report being advised to stop smoking by their physician, very few actually access specialist support to stop (5% coronary patients and 3% high-risk individuals).
The EUROACTION PLUS model (EA+) was developed by Professor Wood’s team at the International Centre for Circulatory Health at Imperial College London to help high-risk patients (atherosclerotic disease, high multifactorial risk of developing the disease, or diabetes) identified in general practice, and their partners, to achieve the lifestyle, risk factor, and therapeutic targets defined in the prevention guidelines. Professor Wood and colleagues conducted a randomized trial in four countries in general practice, to test whether the EA+ model was effective in everyday clinical practice. Led by nurses trained to deliver a comprehensive lifestyle and risk factor management program, the study focused on the family. Along with smoking cessation, the trial addressed dietary and physical activity habits, being overweight and obese, and other risk factors such as blood pressure, cholesterol, and use of cardioprotective drugs.