IJCS | Volume 32, Nº6, November / December 2019

579 Duarte et al. Chocolate consumption and infarction Int J Cardiovasc Sci. 2019;32(6):576-582 Original Article ThemeanLVEF among thosewho consumed chocolate (48.7 ± 15.3) did not present any significant difference to those who did not consume chocolate (51.2 ± 13.0), with p = 0.228. The other variables are presented in Table 3. Among the patients who consumed chocolate, there was a negative correlation between the amount consumed and Syntax (r = -0.296, p = 0.019), characterizing a lower complexity of coronary lesions in patients consuming more chocolate. (Table 4). Discussion This study analyzed the complexity of coronary lesions and the severity of the first infarction with chocolate consumption. The data showed that, among patients who consume chocolate, there is a negative correlation between Syntax and the amount consumed, characterizing lower Table 3 - Association between chocolate consumption and quantitative variables Variables Chocolate consumption p value Yes No Age* 58.5 ± 11.6 59.2 ± 10.9 0.639 BMI* 27.9 ± 4.7 27.6 ± 5.1 0.624 Waist* 97.4 ± 14.8 95.0 ± 13.5 0.202 LVEF* 48.7 ± 15.3 51.2 ± 13.0 0.228 Weight† 74 (64.0–86.0) 74 (65.0 - 82.0) 0.386 Syntax† 14 (6.8 - 18.6) 11 (6.0 - 19.0) 0.778 TIMI frame† 28 (12.0 - 48.0) 20 (14.0 - 32.5) 0.360 * = Mean±standard deviation, † = Median (Interquartile range); BMI: Body mass index; FEVE: Left ventricular ejection fraction. Table 4 - Correlation between chocolate consumption and variables associated with coronary complexity and severity of infarction in patients who had chocolate Variables r p value LVEF* -0.070 0.613 TIMI frame 0.131 0.499 Syntax -0.296 0.019 * = Left ventricular ejection fraction. severity of coronary lesion inpatientswho had chocolate in larger amounts. In addition, there was a lower prevalence of hypertension, diabetes and smoking among those who consumed chocolate. Similarities were found in the literature regarding the profile of the interviewed population, with a higher prevalence of males in patients affected by AMI. 13-17 In addition, it was found that most of these patients had hypertension as a risk factor for the cardiovascular event 13-16 . Regarding smoking, less than half of the population interviewed had this addiction, as also found in other publications. 14,15,17 There was a lower prevalence of hypertension among those who consumed chocolate. This relationship has also been found in several other studies, which have shown reduced blood pressure with consumption of flavonoids, which are present in foods such as chocolate. 4,8,18,19 This association can be justified by the fact that flavonoids would improve endothelial function, since endothelial dysfunction is associated with hypertrophy and arterial wall stiffening. 18,20,21 One of themechanisms of endothelial function improvement is the increased bioavailability of nitric oxide from the consumption of flavonoids, which results in a vasodilator effect and increases blood flow in the vessels, with consequent reduction in blood pressure levels. 22,23 Another important route of the benefits of flavonoids in reducing blood pressure is the inhibition of the angiotensin converting enzyme activity, as the formation of angiotensin II results in vasoconstriction and increased blood pressure, which increases the risk of cardiovascular outcomes. 23,24 An association was also found between the use of alcohol and drugs with chocolate consumption, and a higher prevalence of consumption of these substances among patients have drink chocolate on a weekly basis. Some studies justify this relationship by the addictive characteristics of chocolate, which has compounds that can cause addiction, as in other substances, such as alcohol and other drugs. 25,26 Moreover, chocolate addiction also includes the typical stages of alcoholism and other drug addictions, such as relapse. At this stage, the individual goes back to having chocolate compulsively, without thinking about the adverse effects of exaggerated consumption, which further corroborates the additive effect of chocolate, which may prevail in those who are prone to addictive behaviors. 27 Another relevant point is that drugs, such as marijuana, are appetite stimulants, so they can increase the consumption of foods, including chocolate. 28,29