Given the impact of eating habits on cardiovascular disease and the epidemiological evidence of protective factors present in the diet of specific populations (7), significant emphasis has recently been placed on the identification of dietary elements exerting beneficial effects on the vasculature and on the elucidation of their molecular mechanism. The flavonoids, a ubiquitous class of plant-derived polyphenols, have been proposed as likely candidates, given the link between an increased dietary intake of these phytochemicals and a reduction in cardiovascular events (8). The flavonoids comprise several distinct subclasses, which are present in different concentrations in various foods, including, but not limited to, red wine, black tea, onions, apples, and cocoa (9). While red wine and tea have attracted the initial focus of the scientific community, only in the last decade attention has been brought to the flavanol-rich cocoa. The interest in the effects of cocoa intake on the cardiovascular system was initially triggered by the observation that the indigenous Kuna Indians, a population living in an island off the coast of Panama, have a very low incidence of hypertension (10) and significantly lower death rates for ischemic heart disease, stroke, diabetes, and cancer when compared with the Kuna Indians living in urban Panama city (11). Among the potential factors underlying the differences between the 2 populations, dietary habits were found to be the most likely candidates. In particular, the high intake of home-prepared cocoa, extremely rich in flavanols, in the indigenous Kuna appeared to confer a relevant protective effect (9). Numerous subsequent investigations have also confirmed the inverse relation between dietary cocoa, blood pressure, and cardiovascular mortality in Western populations (12), and have laid the foundation for studies aimed at elucidating the underlying pathophysiological mechanisms. Given the role of the endothelium in hypertension and atherosclerosis, research efforts have focused on the acute and chronic effects of flavanol-rich cocoa on endothelial vasodilator function. After the initial report of strong peripheral nitric oxide (NO)-dependent vasodilation in healthy subjects (13), flavanol-rich cocoa has been shown to reverse endothelial dysfunction, measured as flow-mediated dilation (FMD) of the brachial artery, in smokers (14) and in hypertensive patients (15). Of note, in the latter population, dark chocolate also decreases low-density lipoprotein cholesterol, lowers blood pressure, and improves insulin sensitivity (15). Furthermore, in an intriguing study in heart transplant recipients, dark chocolate has been shown to improve endothelium-dependent responses in the coronary circulation and to decrease shear stress-induced platelet adhesion (16), suggesting that flavanols may directly affect atherothrombosis. However, whether similar beneficial actions are also present in patients with type 2 diabetes is unknown.