Cocoa extract is a supplement made from cocoa that supplies cocoa flavanols, including (-)-epicatechin. In the large COSMOS trial, it did not significantly lower total heart and blood vessel events, though deaths from cardiovascular disease were 27% lower.
Also known as: cocoa flavanols, epicatechin.
COSMOS used a cocoa extract supplying 500 mg of flavanols a day, including 80 mg of (-)-epicatechin (Sesso 2022). These are study protocols, not a recommendation.
It is sold in the US as a dietary supplement. Under the 1994 dietary supplement law (DSHEA), FDA does not approve dietary supplements before they are marketed, and the maker, not FDA, is responsible for safety and labeling.
What studies show: COSMOS randomly assigned 21,442 US adults aged 60 and older without major heart disease to cocoa extract or placebo. Over a median 3.6 years, total cardiovascular events (heart attack, stroke, artery procedures and others) were not significantly lower (410 versus 456 people), but cardiovascular deaths were 27% lower, and analyses limited to people who kept taking the pills supported a lower risk of events; the authors say more research is needed (Sesso 2022). In 573 participants who had detailed memory and thinking tests, 2 years of cocoa extract did not improve cognition compared with placebo (Vyas 2024).
Safety: the COSMOS investigators reported no safety concerns (Sesso 2022). The sources here do not describe drug interactions.
We could not find a single published half-life or time to peak for cocoa flavanols that applies to a supplement dose, so we do not list one.
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