TABLE 3.
Chocolate intake, HRs, and 95% CIs for incident CHD or stroke showing the effects of age (P for interaction = 0.02) in the WHI1
| Frequency2 of chocolate consumption [1-oz (28.35 g) servings] | ||||||
|---|---|---|---|---|---|---|
| Covariates in the model | <1/mo3 | 1 to <1.5/mo | 1.5 to <3.5/mo | 3.5/mo to <3/wk | ≥3/wk | P for linear trend4 |
| Women aged <65 y | ||||||
| Age, race, and WHI study arm (n = 52,173) | ||||||
| HR (95% CI)5 | 1.00 | 1.14 (0.98, 1.32) | 1.06 (0.92, 1.22) | 1.10 (0.96, 1.25) | 1.34 (1.17, 1.54) | <0.0001 |
| Women, n6 | 15,027 | 7871 | 9082 | 12,253 | 7940 | 52,173 |
| Events, n6 | 482 | 292 | 317 | 439 | 347 | 1877 |
| Full model7 (n = 47,506) | ||||||
| HR (95% CI) | 1.00 | 1.17 (1.00, 1.36) | 1.05 (0.90, 1.22) | 1.09 (0.94, 1.25) | 1.27 (1.09, 1.49) | 0.005 |
| Women, n | 13,733 | 7189 | 8287 | 11,148 | 7149 | 47,506 |
| Events, n | 423 | 264 | 281 | 401 | 319 | 1688 |
| Women aged ≥65 y | ||||||
| Age, race, and WHI study arm (n = 39,642) | ||||||
| HR (95% CI) | 1.00 | 1.04 (0.95, 1.15) | 1.07 (0.97, 1.17) | 1.01 (0.93, 1.09) | 1.06 (0.97, 1.17) | 0.35 |
| Women, n | 12,479 | 5863 | 6527 | 9079 | 5694 | 39,642 |
| Events, n | 1307 | 658 | 737 | 996 | 651 | 4349 |
| Full model (n = 72,988) | ||||||
| HR (95% CI) | 1.00 | 1.04 (0.95, 1.15) | 1.05 (0.96, 1.16) | 0.95 (0.87, 1.04 | 0.99 (0.89, 1.10) | 0.49 |
| Women, n | 11,225 | 5312 | 5925 | 8229 | 5113 | 35,804 |
| Events, n | 1161 | 596 | 668 | 878 | 572 | 3875 |
1Incident CHD was the first occurrence of, or death due to, CHD between the baseline survey (1993–8) and 30 September 2013. Incident stroke was the first occurrence of, or death due to, stroke in the same time period. Our sample included observational study and clinical trial control participants without: 1) implausible FFQ energy intakes (defined as mean intakes <600 or >5000 kcal/d), or extreme energy intake (<600 or >5000 kcal/d), BMI ( kg/m2; <15 or >50), or height <122 cm (4 ft); or 2) any of the following pre-existing major chronic conditions at follow-up baseline: diabetes, angina, myocardial infarction, stroke, heart failure, coronary artery bypass graft, percutaneous coronary intervention, or cancer. CHD, coronary heart disease; FFQ, food-frequency questionnaire; MET, metabolic equivalent; WHI, Women's Health Initiative.
2Frequency of chocolate intake was assessed by means of a semi-quantitative FFQ.
3Referent chocolate consumption category.
4Tests for linear trend were performed by using the median for each chocolate intake level as the sole predictor in the model.
5HRs and 95% CIs were determined by means of Cox regression.
6Women, n is the number of participants at year 0 (baseline) without pre-existing serious chronic disease at year 0 who provided data on all variables at year 0. Events, n is the number of incident events or deaths of the condition during the 13.4-y follow-up period. n for the full model is lower than for the model with age, race, and WHI study arm as covariates because of missing values for some of the extra covariates in the full model.
7Basic model covariates were age (years), race/ethnicity (white, black, other), and WHI study arm. The full model included additional continuous and categorical variables. The continuous variables were: the revised Alternative Healthy Eating Index (10); nonchocolate daily energy intake (derived from FFQ data); physical activity (total energy expended from recreational physical activity in MET-h/wk); smoking status (0 = never, 1 = past, 2 = current); alcohol intake (1 = nondrinker, 2 = past drinker, 3 = <1 drink/mo, 4 = <1 drink/wk, 5 = 1 to <7 drinks/wk, 6 = ≥7 drinks/wk), educational level (11 levels), and income status (9 levels).The one additional categorical variable was family history of CVD (yes/no).