The effectiveness and cost effectiveness of dark chocolate consumption as prevention therapy in people at high risk of cardiovascular disease: best case scenario analysis using a Markov model

Objective To model the long term effectiveness and cost effectiveness of daily dark chocolate consumption in a population with metabolic syndrome at high risk of cardiovascular disease. Design Best case scenario analysis using a Markov model. Setting Australian Diabetes, Obesity and Lifestyle study. Participants 2013 people with hypertension who met the criteria for metabolic syndrome, with no history of cardiovascular disease and not receiving antihypertensive therapy. Main outcome measures Treatment effects associated with dark chocolate consumption derived from published meta-analyses were used to determine the absolute number of cardiovascular events with and without treatment. Costs associated with cardiovascular events and treatments were applied to determine the potential amount of funding required for dark chocolate therapy to be considered cost effective. Results Daily consumption of dark chocolate (polyphenol content equivalent to 100 g of dark chocolate) can reduce cardiovascular events by 85 (95% confidence interval 60 to 105) per 10 000 population treated over 10 years. $A40 (£25; €31; $42) could be cost effectively spent per person per year on prevention strategies using dark chocolate. These results assume 100% compliance and represent a best case scenario. Conclusions The blood pressure and cholesterol lowering effects of dark chocolate consumption are beneficial in the prevention of cardiovascular events in a population with metabolic syndrome. Daily dark chocolate consumption could be an effective cardiovascular preventive strategy in this population.

[1]  D. Spiegelhalter,et al.  Incorporation of uncertainty in health economic modelling studies , 2012, PharmacoEconomics.

[2]  David L Katz,et al.  Cocoa and chocolate in human health and disease. , 2011, Antioxidants & redox signaling.

[3]  D. Field,et al.  Consumption of cocoa flavanols results in an acute improvement in visual and cognitive functions , 2011, Physiology & Behavior.

[4]  Stavros Petrou,et al.  Economic evaluation using decision analytical modelling: design, conduct, analysis, and reporting , 2011, BMJ : British Medical Journal.

[5]  C. Fraga,et al.  Cocoa flavanols: effects on vascular nitric oxide and blood pressure , 2010, Journal of clinical biochemistry and nutrition.

[6]  Stephen Colagiuri,et al.  Economic model system of chronic diseases in Australia: a novel approach initially focusing on diabetes and cardiovascular disease , 2010, Int. J. Simul. Process. Model..

[7]  Ping Zhang,et al.  Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review , 2010, Diabetes Care.

[8]  R. Hui,et al.  Short-term effect of cocoa product consumption on lipid profile: a meta-analysis of randomized controlled trials. , 2010, The American journal of clinical nutrition.

[9]  N. Stocks,et al.  Does chocolate reduce blood pressure? A meta-analysis , 2010, BMC medicine.

[10]  R. Woolson,et al.  Does dark chocolate have a role in the prevention and management of hypertension?: commentary on the evidence. , 2010, Hypertension.

[11]  S. Grundy,et al.  Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International As , 2009, Circulation.

[12]  N. Stocks,et al.  Dark chocolate or tomato extract for prehypertension: a randomised controlled trial , 2009, BMC complementary and alternative medicine.

[13]  G. Lippi,et al.  Dark chocolate: consumption for pleasure or therapy? , 2009, Journal of Thrombosis and Thrombolysis.

[14]  R. Muniyappa,et al.  Cocoa consumption for 2 wk enhances insulin-mediated vasodilatation without improving blood pressure or insulin resistance in essential hypertension. , 2008, The American journal of clinical nutrition.

[15]  J. Blumberg,et al.  Blood pressure is reduced and insulin sensitivity increased in glucose-intolerant, hypertensive subjects after 15 days of consuming high-polyphenol dark chocolate. , 2008, The Journal of nutrition.

[16]  T. Rassaf,et al.  Sustained benefits in vascular function through flavanol-containing cocoa in medicated diabetic patients a double-masked, randomized, controlled trial. , 2008, Journal of the American College of Cardiology.

[17]  Thomas Faunce,et al.  Decision-analytical modelling in health-care economic evaluations , 2008, The European Journal of Health Economics.

[18]  C. Lehmann,et al.  Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. , 2007, JAMA.

[19]  E. Schömig,et al.  Effect of cocoa and tea intake on blood pressure: a meta-analysis. , 2007, Archives of internal medicine.

[20]  M. Macht,et al.  Everyday mood and emotions after eating a chocolate bar or an apple , 2006, Appetite.

[21]  Deepak L. Bhatt,et al.  The REduction of Atherothrombosis for Continued Health (REACH) Registry: an international, prospective, observational investigation in subjects at risk for atherothrombotic events-study design. , 2006, American heart journal.

[22]  R. D'Agostino,et al.  Metabolic Syndrome as a Precursor of Cardiovascular Disease and Type 2 Diabetes Mellitus , 2005, Circulation.

[23]  J. Blumberg,et al.  Cocoa Reduces Blood Pressure and Insulin Resistance and Improves Endothelium-Dependent Vasodilation in Hypertensives , 2005, Hypertension.

[24]  J. Salonen,et al.  Dark chocolate consumption increases HDL cholesterol concentration and chocolate fatty acids may inhibit lipid peroxidation in healthy humans. , 2004, Free radical biology & medicine.

[25]  Tai M Huynh.  Convenience care: a patient-centered mode duling. , 2004, Physician executive.

[26]  Johan L Severens,et al.  Discounting health outcomes in economic evaluation: the ongoing debate. , 2004, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[27]  I. Macdonald,et al.  Cocoa, flavanols and cardiovascular risk , 2004 .

[28]  N. Hollenberg,et al.  Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans , 2003, Journal of hypertension.

[29]  M. Serafini,et al.  Plasma antioxidants from chocolate , 2003, Nature.

[30]  W. Klaus,et al.  Chocolate and blood pressure in elderly individuals with isolated systolic hypertension. , 2003, JAMA.

[31]  Elinor Miller,et al.  Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR* Trial). , 2003, The American journal of cardiology.

[32]  N J Wald,et al.  Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials , 2003, BMJ : British Medical Journal.

[33]  C. Keen,et al.  Cocoa and chocolate flavonoids: implications for cardiovascular health. , 2003, Journal of the American Dietetic Association.

[34]  Gerard J Fitzsimmons,et al.  From the Australian Institute of Health and Welfare , 2014, Communicable diseases intelligence quarterly report.

[35]  J. Shaw,et al.  The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)--methods and response rates. , 2002, Diabetes research and clinical practice.

[36]  M. Johannesson,et al.  The cost-effectiveness of a cardiovascular risk reduction program in general practice. , 1997, Health policy.

[37]  J R Beck,et al.  Markov Models in Medical Decision Making , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[38]  K. Anderson,et al.  Cardiovascular disease risk profiles. , 1991, American heart journal.