Kakao und dunkle Schokolade zur kardiovaskulären Prävention?

 

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Zusammenfassung

Ein Verzehr von Kakao und dunklen Schokoladen beeinflusst beim Menschen mehrere relevante kardiovaskuläre Surrogatmarker günstig. So kommt es zu einer arteriellen Gefäßdilatation und leichten Senkung des arteriellen Blutdrucks, zu einer Hemmung der Thrombozytenaggregation und einer Vermehrung der zirkulierenden angiogenetischen Progenitor-Zellen im Blut. Weiter sind antiinflammatorische Effekte, Verbesserungen von Blutfettzusammensetzung und Glucosestoffwechsel beschrieben. Eine vermehrte endotheliale Produktion von Stickoxid (NO) unter Einfluss der auch antioxidativ wirkenden Kakaoflavanole Catechin und Epicatechin wird als wesentlicher biochemischer Mechanismus hinter vielen dieser Effekte angesehen. Direkte kardioprotektive Effekte waren in tierexperimentellen Studien als Verkleinerung von Reperfusionsinfarkten nachweisbar. In prospektiven Kohortenstudien aus Holland, Schweden und den USA wurden unter Kakaoprodukten im Vergleich zu Kontrollen dosisabhängige > 50 %ige Reduktionen der Mortalität besonders infolge Myokardinfarkt offenkundig. Obgleich kontrollierte klinische Endpunktstudien derzeit noch ausstehen, erscheint uns die Empfehlung, Kakaoprodukte mit hohem Flavonoidgehalt zur Prävention der koronaren Herzerkrankung zu verzehren, keineswegs schlechter begründet als viele andere diätetische Empfehlungen. Werden dabei die empfohlenen moderaten Mengen von maximal etwa 25 g/Tag dunkler Schokoladen (ca. 85 %iger Kakaogehalt) eingehalten, sind potenziell schädliche Effekte durch den Kalorien- oder Kadmiumgehalt der Kakaoprodukte minimal und der zu erwartende Nutzen überwiegt deutlich.

Abstract

It has been shown that the consumption of cocoa has a positive influence on a number of cardiovascular surrogate parameters such as arterial vasodilatation and a moderate decrease in blood pressure in humans. In the blood, a decrease in platelet aggregation and an increase in angiogenetic progenitor cells was noted. Furthermore, anti-inflammatory effects, an amelioration of the lipid profile and glucose metabolism was described. An increase of endothelial NO production following the ingestion of the antioxidant cocoa flavanols catechin and epicatechin seems to be the leading mechanism causing these effects. In animal studies of myocardial reperfusion, a decrease in infarct size was noted. In several prospective cohort studies from Europe and the United States, a 50 % reduction of mortality mostly due to a reduction of myocardial infarction was published. Consumption up to about 25 g daily of a flavanol rich dark chocolate (ca. 85 % cocoa content) can be recommended for cardiovascular prevention. In this moderate dosage, the potentially harmful effects due to weight gain and cadmium intake will be minimal. However, controlled randomized trials with well defined clinical endpoints are needed to prove the positive effects described so far. At this point, in time based on the information described in this article, a moderate consumption of flavanol rich cocoa products seems to be effective in the prevention of coronary artery disease and myocardial infarction.

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