Cardiovascular Protective Effects and Mechanisms of Action of Cacao: A Comprehensive Review

Cacao, the primary raw material for chocolate and certain beverages, is widely cultivated in the Americas and Asia. Furthermore, various components of cacao, including phenolic compounds, have been shown to be effective in preventing numerous diseases. Notably, cacao is particularly effective in preventing cardiovascular diseases (CVDs) by regulating various biomarkers and signaling pathways. The functionality of cacao has been reported in multiple <i>in vitro</i> and <i>in vivo</i> studies and clinical trials, thereby further confirming its efficacy. However, comprehensive reviews on the recently reported preventive effects of cacao on CVDs and the related mechanisms <i>in vitro</i>, <i>in vivo</i>, and in clinical trials remain limited. Thus, this review aimed to provide an overview of the latest research results on the effects of cacao on the prevention of CVDs and on biomarkers associated with these mechanisms. Cacao shows significant potential to prevent and mitigate CVDs, with promising findings that could shape the future of cardiovascular health and functional plant innovation. However, to fully harness the potential of cacao, future research must focus on standardizing bioactive compound content, assessing bioavailability and metabolic pathways, and establishing dose-response relationships across diverse populations.