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I don’t see how Dr. Labos can be so definitive that theCOSMOS study rules out a cardiovascular benefit. Here are the results from the abstract:

During a median follow-up of 3.6 y, 410 participants taking cocoa extract and 456 taking placebo had confirmed total cardiovascular events (HR: 0.90; 95% CI: 0.78, 1.02; P = 0.11). For secondary endpoints, HRs were 0.73 (95% CI: 0.54, 0.98) for CVD death, 0.87 (95% CI: 0.66, 1.16) for MI, 0.91 (95% CI: 0.70, 1.17) for stroke, 0.95 (95% CI: 0.77, 1.17) for coronary revascularization, neutral for other individual cardiovascular endpoints, and 0.89 (95% CI: 0.77, 1.03) for all-cause mortality. Per-protocol analyses censoring follow-up at nonadherence supported a lower risk of total cardiovascular events (HR: 0.85; 95% CI: 0.72, 0.99). There were no safety concerns.

Even though mostly not statistically significant, for every outcome listed here, the cocoa extract group did better. This suggests that the study was underpowered. An 11% reduction in all cause mortality would be something to be excited about if it could be replicated across a population large enough to establish statistical significance. The benefits may not be fully proven but they certainly cannot be dismissed.

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