Chocolate and Cardiovascular Health The Bitter Evidence

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1 Chocolate and Cardiovascular Health The Bitter Evidence Pam R. Taub, MD FACC Assistant Professor of Medicine Division of Cardiovascular Medicine Women s Wellness Day March 22, 2014

2 Overview of Talk Prevalence of heart disease in women Case presentation Overview of cardiovascular risk factors The chocolate story Research on beneficial effects of dark chocolate

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4 Heart disease causes 1 in 3 women s deaths each year, killing approximately one woman every minute. Heart Disease

5 Case Presentation 53 year old female with history of hypertension started noticing increased fatigue and sweating with increased activity. She thought she was just having a hot flash. She also has been experiencing neck and jaw pain and thought she just slept in a bad position. She feels occasional palpitations and told her friend about it who thought she had anxiety or a mini panic attack as she is under a lot of stress. She then went for a walk uphill and felt shortness of breath and collapsed. Paramedics were called and she was brought into the emergency room at UCSD.

6 6 Case Presentation

7 7 Case Presentation

8 Case Presentation: Risk Factors for Heart Disease LDL (bad) cholesterol was high at 150 Her hypertension was not well controlled She had metabolic syndrome and slightly elevated blood sugars and had increased abdominal width.

9 9 Coronary Heart (Artery) Disease

10 Common Modifiable Risk Factors Smoking Hypertension Diabetes High Cholesterol Overweight Inactivity Coronary Heart Disease (CHD)

11 Atherosclerosis is a DIFFUSE DISEASE driven by inflammation and elevated levels of bad cholesterol.

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13 Treatment of High Cholesterol Statins (e.g. Lipitor, Crestor) Niacin Zetia Natural Supplements Red Yeast Rice Fish Oil Subtleties to managing cholesterol and use of biomarkers (blood tests)

14 REVERSAL Trial and Use of Statins Key Finding: Intensive lipid-lowering treatment with atorvastatin for 18 months reduced progression of plaque in patients. Nissen SE et al. JAMA 2004;291:

15 Heart Disease is Preventable

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18 CACAO in MesoAmerica For over 3500 years, chocolate has been associated with luxury. The Olmeca, Aztec, and Mayan cultures were greatly influenced by Cacao. The Maya culture transmitted knowledge of cacao by means of oral tradition, multicolored stone engravings, paintings, ceramics and codices where its medicinal uses were described

19 The Unusual Powers of Cacao The Mayans & Aztecs believed that eating cacao would make them strong & invincible

20 Fast Forward to Modern Day: The Kuna Indian Story

21 The Kuna Indians are living proof of the benefits of cacao consumption Kuna islanders consume a high amount of a crude cocoa beverage containing high amounts of the compound epicatechin Epicatechin is responsible for the bitter taste of dark chocolate

22 KUNA vs. US Death Rates DISEASE MAINLAND ISLAND USA CARDIOVASCULAR 83.4± ± CANCER 68.4± ± DIABETES 24.1± ± STATS PER 100,000 Int J Med Sci. 2000, ;4:53-58

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25 Epicatechin : A Pleiotropic Compound Epicatechin Decreases blood pressure Improved Insulin Sensitivity Decreases Platelet Adhesion Lowers incidence of MI and Stroke Prevents age related decline in kidney function Reduces LDL cholesterol No known toxicity Adapted from Corti et al, Circulation 2009

26 Epicatechin Reduces Infarct Size by 82% Control: No treatment Epicatechin 10 mg/kg Infarcted area Area at risk Undamaged tissue Infarcted area p=<0.001 n=6

27 27

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29 29

30 Our research at UCSD suggests epicatechin works on the mitochondria which produce energy for the body Mitochondria manufacture ATP which fuels all cell s & thus the bodies activities

31 31 Changes in Cristae After 3 months of Dark Chocolate Consumption

32 Recent Epidemiological Evidence Chocolate consumption and mortality following a first acute myocardial infarction: the Stockholm Heart Epidemiology Program. Janszky I et al., J Intern Med, 266:248, 2009 Chocolate intake and incidence of heart failure: a population-based prospective study of middle-aged and elderly women. Mostofsky E et al., Circ Heart Fail, 3:612, 2010 Chocolate consumption in relation to blood pressure and risk of cardiovascular disease in German adults. Buijsse B et al., Eur Heart J, 31:1616, 2010 Chocolate consumption is inversely associated with prevalent coronary heart disease: The National Heart, Lung, and Blood Institute Family Heart Study. Djoussé L et al., Clin Nutr, 2010 Chocolate consumption is inversely associated with calcified atherosclerotic plaque in the coronary arteries: The NHLBI Family Heart Study. Djoussé L et al., Clin Nutr, 2010

33 What You Can Do Consume SMALL amounts of dark chocolate (at least 60% dark) once a day. A small square = 30 CALORIES The more bitter the chocolate the better 33

34 34 What if you don t like chocolate?

35 35

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