Although neither supplement significantly reduced the primary outcome of total cardiovascular events, those randomized to a cocoa flavanol supplement had a 27% lower rate of cardiovascular death, a secondary endpoint established pre-specified.
“When we reviewed the full body of evidence for both primary and secondary cardiovascular endpoints in COSMOS, we found promising signals that cocoa flavanol supplementation may reduce important cardiovascular events, including including deaths from cardiovascular disease,” Sesso said. “These findings merit further study to better understand the effects of cocoa flavanols on cardiovascular health.”
“Previous studies have suggested the health benefits of flavanols – compounds in a number of plant-based foods including cocoa, tea, grapes and berries.” Manson said. “COSMOS is not a chocolate test – rather, it’s a rigorous test of a cocoa extract supplement containing levels of cocoa flavanols that a person can never digest. actual gain from chocolate without adding too many calories, fat and sugar to their diet.”
Smaller, short-term trials have found the cardiovascular benefits of cocoa flavanols on blood pressure and blood vessel dilation. COSMOS provided the first opportunity to investigate whether cocoa flavanol supplements might also lead to a longer-term reduction in clinical cardiovascular events. Investigators are also looking for ways to reduce cancer risk. In addition, the trial was designed to test a multivitamin popular in the prevention of cancer and cardiovascular disease.
The primary cardiovascular outcome of the cocoa flavanol intervention was a composite of cardiovascular events, including heart attack, stroke, coronary revascularization, cardiovascular death, carotid artery disease, and peripheral artery surgery. and unstable angina.
More than 21,000 participants were randomly assigned to take a daily capsule containing 500 mg of cocoa flavanols (donated by Mars Edge), a multivitamin (donated by GSK Consumer Healthcare), no or both. The study found that cocoa flavanols reduced the total number of cardiovascular events by 10%, but this was not statistically significant. However, several secondary analyzes have provided broader support for the potential benefit of cocoa flavanols on cardiovascular events.
First, those given cocoa flavanol supplements had a 27% reduction in cardiovascular death.
Second, when the team accounted for adherence to study pill (by looking at people taking their study pill regularly), the team saw a stronger reduction in total cardiovascular events 15% and a 39% reduction in mortality from cardiovascular disease.
The third day, The composite endpoint of major cardiovascular events (heart attack, stroke, and cardiovascular death), although not the focus of the trial, was also significantly reduced. The authors note in their report that their promising results on cocoa flavanols and cardiovascular events warrant careful interpretation and emphasize the need for additional studies.
Daily multivitamins had no significant effect on total or individual cardiovascular events. There are no safety concerns with cocoa flavanols or a multivitamin.
COSMOS concluded after about 3.6 years, it was too short to find out whether supplements could affect cancer risk. Although a daily multivitamin improved levels of several nutritional biomarkers, it had no significant effect on fully invasive cancer, which is a key finding for the analyses. multivitamin.
Cocoa flavanols also had no significant effect on fully invasive cancer. The authors note that continued monitoring of COSMOS participants could help clarify any long-term effects on cancer and mortality. Investigators and collaborators are also leveraging COSMOS to study how cognitive decline, falls, eye disease, and other aging-related outcomes may be affected by supplements.
“Although our study shows compelling cardiovascular protection with cocoa flavanols, any health benefits from taking these supplements will need to be confirmed in a prospective trial. future”. Manson said. Add Sesso: “Our message to consumers is to eat a healthy, balanced diet rich in natural food sources of flavanols and to stay tuned as we further evaluate key health outcomes. other in COSMOS.”