The body of research praising the cardiovascular benefits associated with flavonoid antioxidant-rich chocolate has been added to by yet another study praising the sweet confection. For men and women with established coronary heart disease, eating chocolate now and then is a wise indulgence, according to a recently published Swedish study. And while the data doesn’t green light inhaling an entire box of Godiva truffles, it does suggest that those who consume chocolate up to twice a week have a better chance of surviving.

In a population-based inception cohort study published in the September issue of The Journal of Internal Medicine, researchers at the Stockholm Heart Epidemiology Program followed 1169 non-diabetic patients aged 45-70 who were hospitalized with a confirmed first acute myocardial infarction (AMI) between 1992 and 1994. The participants self-reported how many typical 50 g portions of chocolate they had consumed per day and per week over the preceding 12 months with a standardized questionnaire distributed during hospitalization. They then underwent a health examination three months after discharge. Participants were also followed for hospitalizations and mortality with national registries for eight years.

After analyzing the data, the researchers found that a patient’s chocolate consumption had a strong inverse association with cardiac mortality. In fact, the more chocolate they consumed, the better they fared following a heart attack. “When compared with those who rarely or never eat chocolate, the multivariable-adjusted hazard ratios were 0.73 (95% confidence interval, 0.41–1.31), 0.56 (0.32–0.99) and 0.34 (0.17–0.70) for those consuming chocolate less than once per month, up to once per week and twice or more per week, respectively. Chocolate consumption generally had an inverse but weak association with total mortality and nonfatal outcomes. In contrast, intake of other sweets was not associated with cardiac or total mortality,” they reported.

In summary, those who consumed a single portion of chocolate less than once per month had a 27% reduction in their risk for cardiac death, compared to people who ate no chocolate at all. Those who ate at least one 50 g serving of chocolate roughly once a week had a 44% reduction and those who consumed chocolate twice or more a week had a 66% reduced risk of dying from a heart attack.

In the interest of full disclosure, the researchers did not ask patients which kinds of chocolate they consumed—an element worth noting since milk chocolate has a lower flavonoid content than dark chocolate.

“Although our findings support increasing evidence that chocolate is a rich source of beneficial bioactive compounds, confirmation of this strong inverse relationship from other observational studies or large-scale, long-term, controlled randomized trials is needed,” they wrote.

“No study has evaluated the possible prognostic importance of chocolate intake after a heart attack, although, chocolate is known to be rich in biologically active components,” explained Dr. Imre Janszky, one of the study authors and a medical doctor with the Department of Public Health Sciences at the Karolinska Institute at the Karolinska University Hospital in Stockholm, Sweden.

Although Dr. Janszky and his colleagues were aware of the benefits of chocolate, he and his team were astonished by their study results. “The strength of the inverse association was surprising,” he said. “We did not expect such a strong negative relationship.”

Bearing in mind that the study was observational in nature as opposed to a randomized trial, Dr. Janszky said the long term cause and effect of chocolate consumption on this aspect of cardiovascular health merits more research. “It is too early to conclude or give a firm recommendation. Further research is needed,” he said. “A large scale randomized trial targeting hard endpoints (i.e., mortality, cardiac events) would be very interesting.”

Though Dr. Janszky researched previous scenarios relating to heart health, he said that he has no immediate plans to further research the cardio-protective effects chocolate. However, he added, “It would be very interesting to see whether other studies would concur with our findings.”