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An important study just out found cocoa flavanol supplementation at just 500mg per day reduced CVD death by an astounding 27%. Oddly enough, it did not appear to impact other cardiovascular related events (e.g., myocardial infarction, stroke, carotid artery disease, peripheral artery surgery, and unstable angina), but that may have been due to the population of the study (older adults who likley already had CVD) or other factors. Cocoa – via the various flavanols it contains – is the primary bio active ingredient in dark chocolate, and I cover the potential benefits of regular dark chocolate ingestion, HERE. It’s also why cocoa – as unprocessed organic sourced cocoa – a key ingredient in AlphaJoe, which has additional synergism with coffee.

This is a particularly important study as it was so large, and ran as long as it did, and was a direct intervention RCT vs the usual correlational study that makes cause and effect conclusions difficult. This is the first large scale study of its kind to directly test clinical cardiovascular events of cocoa ingestion.

Effect of cocoa flavanol supplementation for prevention of cardiovascular disease events: The COSMOS randomized clinical trial

The American Journal of Clinical Nutrition, 16 March 2022



Cocoa extract is a source of flavanols that favorably influence vascular risk factors in small and short-term trials, yet effects on clinical cardiovascular events are untested.


We examined whether cocoa extract supplementation decreases total cardiovascular disease (CVD) among older adults.


We conducted a randomized, double-blind, placebo-controlled, two-by-two factorial trial of cocoa extract supplementation and multivitamins for prevention of CVD and cancer among 21,442 U.S. adults (12,666 women aged ≥ 65 years and 8,776 men aged ≥ 60 years) free of major CVD and recently diagnosed cancer. Intervention phase was June 2015 through December 2020. This article reports on the cocoa extract intervention. Participants were randomly assigned to a cocoa extract supplement (500 mg/d flavanols, including 80 mg (–)-epicatechins) or placebo. The primary outcome was a composite of confirmed incident total cardiovascular events, including myocardial infarction (MI), stroke, coronary revascularization, cardiovascular death, carotid artery disease, peripheral artery surgery, and unstable angina.


During a median follow-up of 3.6 years, 410 participants taking cocoa extract and 456 taking placebo had confirmed total cardiovascular events (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.78, 1.02; P = 0.11). For secondary endpoints, HRs were 0.73 (95% CI, 0.54, 0.98) for CVD death, 0.87 (95% CI, 0.66, 1.16) for MI, 0.91 (95% CI, 0.70, 1.17) for stroke, 0.95 (95% CI, 0.77, 1.17) for coronary revascularization, neutral for other individual cardiovascular endpoints, and 0.89 (95% CI, 0.77, 1.03) for all-cause mortality. Per-protocol analyses censoring follow-up at nonadherence supported a lower risk of total cardiovascular events (HR, 0.85; 95% CI, 0.72, 0.99). There were no safety concerns.


Cocoa extract supplementation did not significantly reduce total cardiovascular events among older adults but reduced CVD death by 27%. Potential reductions in total cardiovascular events were supported in per-protocol analyses. Additional research is warranted to clarify whether cocoa extract may reduce clinical cardiovascular events.

  1. John Troy 1 year ago

    Cacao and coffee(AlphaJoe)…what’s not to love!

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