COSMOS Study Shows Cocoa Flavanols Reduce Risk of Cardiovascular Death by 27%

Interesting neutraceutical study mentioned by Nir Barzelai on a study by Mars (candy) on Cocao powder: Its been a very successful study, with over 20,000 people participating.

I find that raw Cacao powder (no sugar added) is a great addition to my morning coffee (with spermidine powder also added).

COSMOS includes 21,442 participants –12,666 women aged 65 or older and 8,776 men aged 60 or older – who were followed for an average of 3.6 years through the end of 2020. These are the results for the studied cocoa extract and multivitamin supplements.

We now have the results of the largest and longest randomized trial of daily cocoa extract supplementation, and the largest trial of multivitamin supplementation, for the prevention of cardiovascular disease and cancer! The results were published in The American Journal of Clinical Nutrition (AJCN).

Cocoa Extract Findings

Cocoa extract: During the trial, 410 out of 10,719 participants taking cocoa extract and 456 out of 10,723 participants taking placebo had confirmed total cardiovascular events – including heart attack, stroke, coronary revascularization, death caused by cardiovascular disease, unstable angina requiring hospitalization, carotid artery surgery and peripheral artery surgery. This translates to a modest 10% reduction in cardiovascular events for those taking cocoa extract, but it was not statistically significant.

However, additional analyses provided broader potential support for a benefit on cardiovascular events that highlight the need for more research. When comparing participants who remained compliant with the active cocoa extract and placebo groups, cocoa extract supplementation significantly reduced total cardiovascular events by 15%. Cocoa extract supplementation also reduced deaths due to cardiovascular disease, a pre-specified secondary endpoint, by 27%. Cocoa extract did not significantly reduce other individual cardiovascular outcomes. Participants taking cocoa extract experienced no significant effects on total invasive cancer, individual cancers, or cancer death.

Summary of Cocoa Extract Findings:

  • COSMOS provides the first suggestive evidence that long-term cocoa extract supplementation may favorably impact clinical cardiovascular outcomes, including a significant 27% reduction in cardiovascular death and greater cardiovascular benefits among those taking the study pills regularly.
  • Additional research is needed to understand how cocoa extract supplementation may reduce cardiovascular events through continued follow-up of COSMOS participants and ongoing ancillary studies examining mechanisms of effect along with other aging-related outcomes.

Source: Results – COSMOS Trial


For the last four years, Harvard tracked 21,000 people as they consumed 500mg of cocoa flavanols daily in a placebo-controlled trial. Key topline findings include:

  • 27% reduction in the risk of cardiovascular death (jumps to 39% in participants consuming cocoa flavanols at least 22 days per month!)
  • 24% reduction in major cardiovascular events (heart attack, stroke, or death) among study participants consuming cocoa flavanols daily
  • 18% reduction in deaths, from all causes, among study participants consuming cocoa flavanols daily

COSMOS is actually one of the largest, longest and most comprehensive placebo controlled trials of any drug, supplement or nutrient of all time. While initial COSMOS results are published in The American Journal of Clinical Nutrition, these topline findings are only the beginning.


Full research paper here:

CocoaStudynqac055.pdf (1.8 MB)

Read the published paper here: Final cocoa extract findings

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How do you find cadmium-free cocoa extract? I know there’s a reviews site consumerlab but it costs money (we could just get a group subscription for this forum so everyone here can benefit)

Why not just eat dark chocolate and cocoa powder?
I add Hershey’s cocoa to my plain protein drink for flavoring.

Apparently, Hershey’s cocoa contains acceptably low amounts of lead and cadmium. If it was in any way bad I would be long dead as I have consumed tons of it.
I found an independent source of lead and cadmium levels in some of the more common chocolate products:

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Good question… Here is a short excerpts that may help you:

Ghiradeli - $7.50 USD per bag at Walmart

Ghiradeli - $53.15 USD for same bag to be shipped to Hong Kong

Well, that sucks.

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@RapAdmin Did the report mention anything about this?

NOW Foods, Real Food Cocoa Lovers, Organic Cocoa Powder, 12 oz (340 g) NOW Foods, Real Food Cocoa Lovers, Organic Cocoa Powder, 12 oz (340 g)

NOW Foods, Real Food Cocoa Lovers, Organic Cocoa Powder, 12 oz (340 g)

I can get this here in Hong Kong relatively cheap. 0.3 mcg of cadmium and lead per serving. Quite acceptable.

And then there’s this article that says even if you eat a lot of chocolate cocoa powder and craft chocolate that is high in cadmium, blood and urine tests show that there’s not much in us…

Great article!

I’ve been having a teaspoon of organic cacao powder in my oatmeal for the last few years. Its one of the most potent antioxidants full of healthy flavonoids/polyphenols and the oldest women to live Jeanne Calment - 122 years old - Was noted to eat dark chocolate for most of her life and a lot of it!

Cacao powder is basically raw chocolate - so its not processed - Cocoa powder is roasted I believe so I would personally go for cacao powder to reap most the benefits, however cocoa powder is still better than nothing. Just wanted to note the difference between Cacao and Cocoa.

No - they did not review that product.

You can use this link to find cadmium and lead levels in chocolate and cocoa powder.

At the bottom of the article is a search where you can sort by brand and type of cocoa. Very useful!!!

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Mars has been selling various forms of Cocovia for about 20 years

Where do you get “Spermadine powder”? I can only find capsules (quite expensive) from a company called Spermadinelife.

I have found that Spermidine is more effective when mixed in EVOO. Just my 2 cents…

I got a bunch on a trip to Germany about a year ago… so not something most people would want to do.

When I run out, I’ll go with a synthetic version of spermidine like this:

That Double Wood is a good brand and is about the same price (but a little cheaper) as DoNotAge’s with the 10% off code. So in this case, Double Wood would be the best choice. However, you may need to order several bottles to get the free shipping.

Really? Look at the cost per mg/spermidine. Generally the synthetic products are a small fraction of the cost of the natural products. Comparing the price - DoNotAge is almost 50% higher than the cost per mg. in the USA.

DoNotAge is $0.10 per mg at the highest quantity purchase price

Doublewood is $0.069 per mg.

When I did the calculation just now, Doublewood is $0.083 per mg. The price in your post is USD 49.95.

DoNotAge Spermidine is $0.089 per mg with the 10% off code.

I guess Doublewood is a bit cheaper, and it is a good brand. For some reason when I bought my supply, the DNA was cheaper. I guess the pricing dynamic is constantly in flux and you need to re-evaluate every time you purchase.

I was comparing the “triple pack” Doublewood (360 tablets) and the DoNotAge 366 Tablet purchase prices:

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