This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (114)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Nutritional and Metabolic Disorders  • Nutrition/ Malnutrition  • Hypertension  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: In vitro studies have suggested that flavonoids may have specific vascular effects, but their mechanism of action has not been clarified.¹ A subclass of flavonoids—flavan-3-ols and their oligomers (procyanidins)—are constituents of cocoa beans, which can be detected in human plasma after ingestion of cocoa.² In turn, plant extracts rich in flavan-3-ols can increase the activity of nitric oxide synthase (NOS) in endothelial cells.³ Nitric oxide is an essential signaling molecule in vascular physiology. Nitric oxide bioactivity can be preserved in human plasma in a circulating pool via increases in a number of nitrosated compounds.^4-5 Thus, it is possible that cocoa rich in flavan-3-ols may lead to improved endothelium-dependent dilation via an increase of nitric oxide bioactivity.

However, commercially available cocoa drinks contain only small amounts of flavan-3-ols due to roasting and alkalization of cocoa beans, which are known to degrade flavan-3-ols. We tested the hypothesis that ingestion . . . [Full Text of this Article]

Methods

Christian Heiss, MD; André Dejam, MD; Petra Kleinbongard
Department of Medicine

Tankred Schewe, PhD; Helmut Sies, MD, PhD
Institute Biochemistry and Molecular Biology I

Malte Kelm, MD, PhD
Department of Medicine
Heinrich-Heine-University
Düsseldorf, Germany

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cocoa and Cardiovascular Health
Corti et al.
Circulation 2009;119:1433-1441.
ABSTRACT | FULL TEXT  

Cocoa consumption for 2 wk enhances insulin-mediated vasodilatation without improving blood pressure or insulin resistance in essential hypertension
Muniyappa et al.
Am. J. Clin. Nutr. 2008;88:1685-1696.
ABSTRACT | FULL TEXT  

Pure dietary flavonoids quercetin and (-)-epicatechin augment nitric oxide products and reduce endothelin-1 acutely in healthy men
Loke et al.
Am. J. Clin. Nutr. 2008;88:1018-1025.
ABSTRACT | FULL TEXT  

Blood Pressure Is Reduced and Insulin Sensitivity Increased in Glucose-Intolerant, Hypertensive Subjects after 15 Days of Consuming High-Polyphenol Dark Chocolate
Grassi et al.
J. Nutr. 2008;138:1671-1676.
ABSTRACT | FULL TEXT  

Short- and long-term effects of (-)-epicatechin on myocardial ischemia-reperfusion injury
Yamazaki et al.
Am. J. Physiol. Heart Circ. Physiol. 2008;295:H761-H767.
ABSTRACT | FULL TEXT  

Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials
Hooper et al.
Am. J. Clin. Nutr. 2008;88:38-50.
ABSTRACT | FULL TEXT  

Acute dark chocolate and cocoa ingestion and endothelial function: a randomized controlled crossover trial
Faridi et al.
Am. J. Clin. Nutr. 2008;88:58-63.
ABSTRACT | FULL TEXT  

Cocoa procyanidins inhibit expression and activation of MMP-2 in vascular smooth muscle cells by direct inhibition of MEK and MT1-MMP activities
Lee et al.
Cardiovasc Res 2008;79:34-41.
ABSTRACT | FULL TEXT  

Sustained benefits in vascular function through flavanol-containing cocoa in medicated diabetic patients a double-masked, randomized, controlled trial.
Balzer et al.
J Am Coll Cardiol 2008;51:2141-2149.
ABSTRACT | FULL TEXT  

A double-blind, placebo-controlled, randomized trial of the effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health: clinical findings from a sample of healthy, cognitively intact older adults
Crews et al.
Am. J. Clin. Nutr. 2008;87:872-880.
ABSTRACT | FULL TEXT  

Daily Consumption of a Dark Chocolate Containing Flavanols and Added Sterol Esters Affects Cardiovascular Risk Factors in a Normotensive Population with Elevated Cholesterol
Allen et al.
J. Nutr. 2008;138:725-731.
ABSTRACT | FULL TEXT  

Dark Chocolate Improves Coronary Vasomotion and Reduces Platelet Reactivity
Flammer et al.
Circulation 2007;116:2376-2382.
ABSTRACT | FULL TEXT  

Protective effect of atorvastatin on acute systemic inflammation-induced endothelial dysfunction in hypercholesterolaemic subjects
Vlachopoulos et al.
Eur Heart J 2007;28:2102-2109.
ABSTRACT | FULL TEXT  

Effects of Flavonoid-Containing Beverages and EGCG on Endothelial Function
Shenouda and Vita
J. Am. Coll. Nutr. 2007;26:366S-372S.
ABSTRACT | FULL TEXT  

Effect of Cocoa and Tea Intake on Blood Pressure: A Meta-analysis
Taubert et al.
Arch Intern Med 2007;167:626-634.
ABSTRACT | FULL TEXT  

Acute EGCG Supplementation Reverses Endothelial Dysfunction in Patients with Coronary Artery Disease
Widlansky et al.
J. Am. Coll. Nutr. 2007;26:95-102.
ABSTRACT | FULL TEXT  

THE TRUTH IS OFTEN BITTERSWEET...: CHOCOLATE DOES A HEART GOOD
Alspach
Crit Care Nurse 2007;27:11-15.
FULL TEXT  

Immune Effects of Cocoa Procyanidin Oligomers on Peripheral Blood Mononuclear Cells
Kenny et al.
Exp. Biol. Med. 2007;232:293-300.
ABSTRACT | FULL TEXT  

Cocoa intake, blood pressure, and cardiovascular mortality: the zutphen elderly study.
Buijsse et al.
Arch Intern Med 2006;166:411-417.
ABSTRACT | FULL TEXT  

Plasma Nitroso Compounds Are Decreased in Patients With Endothelial Dysfunction
Heiss et al.
J Am Coll Cardiol 2006;47:573-579.
ABSTRACT | FULL TEXT  

(-)-Epicatechin mediates beneficial effects of flavanol-rich cocoa on vascular function in humans
Schroeter et al.
Proc. Natl. Acad. Sci. USA 2006;103:1024-1029.
ABSTRACT | FULL TEXT  

Acute Consumption of Flavanol-Rich Cocoa and the Reversal of Endothelial Dysfunction in Smokers
Heiss et al.
J Am Coll Cardiol 2005;46:1276-1283.
ABSTRACT | FULL TEXT  

Cocoa Reduces Blood Pressure and Insulin Resistance and Improves Endothelium-Dependent Vasodilation in Hypertensives
Grassi et al.
Hypertension 2005;46:398-405.
ABSTRACT | FULL TEXT  

Review: Health Effects of Cocoa Flavonoids
Lamuela-Raventos et al.
Food Science and Technology International 2005;11:159-176.
ABSTRACT  

Impaired Progenitor Cell Activity in Age-Related Endothelial Dysfunction
Heiss et al.
J Am Coll Cardiol 2005;45:1441-1448.
ABSTRACT | FULL TEXT  

Nutritional, Dietary and Postprandial Oxidative Stress
Sies et al.
J. Nutr. 2005;135:969-972.
ABSTRACT | FULL TEXT  

Bioavailability and bioefficacy of polyphenols in humans. II. Review of 93 intervention studies
Williamson and Manach
Am. J. Clin. Nutr. 2005;81:243S-255S.
ABSTRACT | FULL TEXT  

Polyphenols and cardiovascular disease: effects on endothelial and platelet function
Vita
Am. J. Clin. Nutr. 2005;81:292S-297S.
ABSTRACT | FULL TEXT  

Cocoa antioxidants and cardiovascular health
Keen et al.
Am. J. Clin. Nutr. 2005;81:298S-303S.
ABSTRACT | FULL TEXT  

Cocoa polyphenols and inflammatory mediators
Sies et al.
Am. J. Clin. Nutr. 2005;81:304S-312S.
ABSTRACT | FULL TEXT  

Pentameric Procyanidins Isolated from Theobroma cacao Seeds Selectively Downregulate ErbB2 in Human Aortic Endothelial Cells
Kenny et al.
Exp. Biol. Med. 2004;229:255-263.
ABSTRACT | FULL TEXT