Lauren Manaker, MS, RDN, LDN, CLEC, CPT, has studied nutrition for almost two decades. She was named an emerging leader in women's health by the National Academy of Nutrition and Dietetics.

Nick Blackmer is a librarian, fact-checker, and researcher with more than 20 years’ experience in consumer-oriented health and wellness content.

When we hear “cocoa,” many of us think of decadent chocolate bars and warm drinks topped with fluffy marshmallows. However, cocoa is much more than an ingredient in our favorite treats; it actually has a long history of medicinal uses. Part of what makes it special is that cocoa is rich in flavanols.

Catherine Kwik-Uribe, PhD, vice president of Scientific & Regulatory Affairs, Applied Science & Nutrition at Mars Edge, told Verywell that flavanols are “a select group of bioactive compounds found in a variety of foods including apples, grapes, tea, some berries, and cocoa-based products.”

Consuming flavanols has been linked to a range of health benefits, including antioxidant effects and reduced risk of vascular disease. Now, it turns out the chocolatey flavanols in cocoa extract might be good for your heart.

A new study published in the American Journal of Clinical Nutrition found that cocoa supplementation was linked to a lower risk of cardiovascular disease-related death.

To see if cocoa extract supplementation would affect cardiovascular disease in older adults, researchers set up a trial called the COcoa Supplement and Multivitamin Outcomes Study (COSMOS).

The trial included more than 21,000 American adults over the age of 60 years old. The participants were randomly assigned to either a group that took a daily cocoa extract supplement or a group that took a placebo.

The cocoa extract group received 500 mg of cocoa flavanols every day. The supplement contained 80 mg of something called (–)-epicatechin. Previous studies have shown that this specific flavanol found in cocoa may offer cardiovascular benefits (for example, by supporting healthy blood pressure levels).

When they followed up with the participants for about 3.6 years, the researchers found that the cocoa extract supplementation did not have a big effect on the total cardiovascular disease (CVD) events (for example, having a heart attack).

However, the supplement did appear to reduce the participants’ risk of dying from cardiovascular causes by 27%.

Howard D. Sesso, ScD, MPH, associate professor of medicine at Harvard Medical School and director of the Division of Preventive Medicine at Brigham and Women’s Hospital and one of the study’s principal investigators, told Verywell that COSMOS “is the first large-scale, randomized, double-blind, placebo-controlled clinical trial of a cocoa flavanol supplement that found promising signals” for heart disease prevention prevention, but that more research is needed.

Sesso explained that a 10% reduction in heart disease was not statistically significant. But when researchers performed their secondary analysis of the people who had been regularly taking the supplement, they found a “stronger and significant” 15% reduction in cardiovascular events.

The researchers did not note any major adverse effects of taking the supplement and did not have any safety concerns.

In other words, taking a cocoa supplement might offer some heart health benefits and isn’t likely to cause any unwanted side effects.

Despite their name, cocoa beans are not technically beans; they’re the seeds of the fruit of the Theobroma cacao tree. They are used to make chocolate.

Like many other natural, plant-based foods, cocoa beans are full of nutrients that support our overall health—in part due to their flavanol and procyanidin content.

Studies have shown that when people get specific amounts of dietary cocoa in their diets, they may see improvements in their blood pressure readings, inflammation levels, and platelet activation.

If you want to consume more flavanols, Kwik-Uribe suggests starting with small steps like adding “blueberries (fresh or frozen) to your morning yogurt or smoothie, swapping your afternoon coffee for a cup of green tea, and grabbing a pear or handful of nuts as a snack.”

According to Kwik-Uribe, supplements like CocoaVia can help “take the guesswork out” of adding these compounds to your diet, adding that “the extract in all CocoaVia products is the same material used in the COSMOS Trial.”

The cocoa extract also has caffeine in it, which may enhance the vascular and central nervous system effects of cocoa flavanols.

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Sesso HD, Manson JE, Aragaki AK, et al. Effect of cocoa flavanol supplementation for prevention of cardiovascular disease events: the COSMOS randomized clinical trial. Am J Clin Nutr. Published online March 16, 2022. doi:10.1093/ajcn/nqac055

Bernatova I. Biological activities of (-)-epicatechin and (-)-epicatechin-containing foods: focus on cardiovascular and neuropsychological health. Biotechnol Adv. 2018 May-Jun;36(3):666-681. doi:10.1016/j.biotechadv.2018.01.009

Oñatibia-Astibia A, Franco R, Martínez-Pinilla E. Health benefits of methylxanthines in neurodegenerative diseases. Mol Nutr Food Res. 2017 Jun;61(6). doi:10.1002/mnfr.201600670

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