Cocoa flavanols reduce left atrial volume in healthy elderly individuals in a double-blinded randomized trial

Dragos-Andrei Duse (Düsseldorf)1, M. Gröne (Düsseldorf)1, N. Ophoff (Düsseldorf)1, N. Kramser (Düsseldorf)1, H. Schweers (Düsseldorf)1, H. Schroeter (McLean)2, C. Quast (Düsseldorf)1, F. Bönner (Düsseldorf)1, C. Heiss (Surrey)3, R. Sansone (Düsseldorf)1, C. Jung (Düsseldorf)1, M. Kelm (Düsseldorf)1, R. J. Erkens (Düsseldorf)1

1Universitätsklinikum Düsseldorf Klinik für Kardiologie, Pneumologie und Angiologie Düsseldorf, Deutschland; 2Mars Incorporated McLean, USA; 3University of Surrey Faculty of Health and Medical Sciences Surrey, Großbritannien



Diastolic dysfunction (DD) is a common feature of the aging heart associated with impaired exercise capacity and heart failure with preserved ejection fraction (HFpEF). Remodeling and enlargement of the left atrium (LA) are common traits of DD. Since cocoa flavanols (CF) can improve vascular health and cardiopulmonary fitness, we hypothesized that they might counteract markers of DD and LA remodeling in healthy elderly individuals.

Methods and Results:

In a randomized, double-blinded trial (NCT 05782309) we investigated the effects of CF on systolic and diastolic cardiac function in healthy elderly individuals. Sixty-three participants (59% male) aged ≥ 55 years received either 500 mg CF (n=30) or a nutrient-matched placebo (n=33) twice daily for 30 days. Cardiac volumes, mass, strain, strain rates, and markers of systolic function were assessed with high-resolution cardiac magnetic resonance (CMR) imaging before and after supplementation. CF reduced maximal LA volume and LA volume index by 12.6±3.5% (p=0.0063 and p=0.0067) and LV end-diastolic volume (LVEDV) and LVEDV index by ~4.9±1.9% (p=0.049 and p=0.413). No changes occurred for strain, strain rate and systolic function parameters. Systolic blood pressure decreased by 7 mmHg ~4.7±1.9% (p=0.04).


Cocoa flavanols decrease left atrial and ventricular volumes related to diastolic dysfunction, highlighting the potential of cocoa flavanols to maintain myocardial relaxation in otherwise healthy elderly individuals.

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