Cardiovascular Journal of Africa: Vol 31 No 5 (September/October 2020)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 5, September/October 2020

AFRICA

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Participants were also given a treadmill walking test and

had the blood flow to their legs measured using magnetic

resonance imaging. Participants who consented had a calf

muscle biopsy to evaluate muscle health.

The cocoa used in the study is commonly available,

natural, unsweetened cocoa powder, which is rich in the

flavanol epicatechin, found in larger quantities in dark

chocolate (> 85% cacao) than in milk chocolate. Regular

chocolate would not be expected to have the same effect.

Researchers found that the patients who consumed cocoa

showed significant improvement, walking an average of

almost 43 m further in the six-minute walking test compared

to their baseline results during the test performed at 2.5

hours after the final study beverage. Researchers also found

increased mitochondrial activity, increased capillary density,

and other improvements to muscle health in those who

consumed the cocoa.

Patients who drank the placebo beverage had a decline

of 24.2 m in their walking distance at 2.5 hours after the

final study beverage, compared to their baseline results. This

is consistent with other studies, in which people with PAD

without treatment have declines in their six-minute walk

distance over time.

Cocoa appeared to have no effect on treadmill walking

performance. However, McDermott said the treadmill

walking and the six-mile walking test are distinct measures

of walking endurance and do not respond identically to

the same therapy. The improvement in six-minute walking

distance better reflects the type of walking required in daily

life and therefore these results are a more relevant outcome

for patients with PAD.

‘While we expected the improvements in walking, we were

particularly pleased to see that cocoa treatment was also

associated with increased capillary density, limb perfusion,

mitochondrial activity, and an additional measure of overall

skeletal muscle health,’ McDermott said. ‘If our results are

confirmed in a larger trial, these findings suggest that cocoa,

a relatively inexpensive, safe and accessible product, could

potentially produce significant improvements in calf muscle

health, blood flow and walking performance for PAD patients.’

Limits to this pilot study include: a small sample size; an

imbalance between the two study groups in the number of

participants of each gender, race and in body mass index; and

a lack of data for overall dietary consumption.

‘Patients with PAD have difficulty walking that is as bad

as people with advanced heart failure. Leg muscles don’t

get enough blood supply in PAD, leading to injury and in

this study, cocoa appeared to be protecting the muscle and

improving metabolism,’ said Dr Naomi Hamburg, chair

of the American Heart Association’s Peripheral Vascular

Disease Council and author of an editorial on the study that

also appears in this issue. ‘We know that exercise therapy

helps people with PAD walk farther, and this early study

suggests that cocoa may turn out to be a new way to treat

people with PAD. We will need larger studies to confirm

whether cocoa is an effective treatment for PAD, but maybe,

someday, if the research supports it, we may be able to write

a prescription for chocolate for our patients with PAD.’

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