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J Am Heart Assoc. 2014 Jul 2;3(4). pii: e001072. doi: 10.1161/JAHA.114.001072.

Dark chocolate acutely improves walking autonomy in patients with peripheral artery disease.

Author information

1
Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy (L.L., L.P., E.C., P.P., M.B., C.N., S.B., R.C., F.V.).
2
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy (E.D.F., G.F.).
3
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy (E.D.F., G.F.) Department of AngioCardioNeurology, IRCCS NeuroMed, Pozzilli, Italy (G.F.).

Erratum in

  • J Am Heart Assoc. 2014 Aug;3(4):e000456.

Abstract

BACKGROUND:

NOX-2, the catalytic subunit of NADPH oxidase, has a key role in the formation of reactive oxidant species and is implicated in impairing flow-mediated dilation (FMD). Dark chocolate exerts artery dilatation via down-regulating NOX2-mediated oxidative stress. The aim of this study was to investigate whether dark chocolate improves walking autonomy in peripheral artery disease (PAD) patients via an oxidative stress-mediated mechanism.

METHODS AND RESULTS:

FMD, serum levels of isoprostanes, nitrite/nitrate (NOx) and sNOX2-dp, a marker of blood NOX2 activity, maximal walking distance (MWD) and maximal walking time (MWT) were studied in 20 PAD patients (14 males and 6 females, mean age: 69±9 years) randomly allocated to 40 g of dark chocolate (>85% cocoa) or 40 g of milk chocolate (≤35% cocoa) in a single blind, cross-over design. The above variables were assessed at baseline and 2 hours after chocolate ingestion. Dark chocolate intake significantly increased MWD (+11%; P<0.001), MWT (+15%; P<0.001), serum NOx (+57%; P<0.001) and decreased serum isoprostanes (-23%; P=0.01) and sNOX2-dp (-37%; P<0.001); no changes of the above variables were observed after milk chocolate intake. Serum epicatechin and its methylated metabolite significantly increased only after dark chocolate ingestion. Multiple linear regression analysis showed that Δ of MWD was independently associated with Δ of MWT (P<0.001) and Δ of NOx (P=0.018). In vitro study demonstrated that HUVEC incubated with a mixture of polyphenols significantly increased nitric oxide (P<0.001) and decreased E-selectin (P<0.001) and VCAM1 (P<0.001).

CONCLUSION:

In PAD patients dark but not milk chocolate acutely improves walking autonomy with a mechanism possibly related to an oxidative stress-mediated mechanism involving NOX2 regulation.

CLINICAL TRIAL REGISTRATION URL:

http://www.clinicaltrials.gov. Unique identifier: NCT01947712.

KEYWORDS:

antioxidant; atherosclerosis; chocolate; oxidant stress; peripheral vascular disease

Comment in

PMID:
24990275
PMCID:
PMC4310398
DOI:
10.1161/JAHA.114.001072
[Indexed for MEDLINE]
Free PMC Article

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