From the Journals

Plant-based diet lowers risk of heart failure

View on the News

An advance toward dietary measures to prevent heart failure

This analysis of the REGARDS study contributes toward creating a strong evidence base for the prevention of heart failure through dietary measures, wrote Dong D. Wang, SCD, MD, a visiting scientist at Harvard School of Public Health, Boston, in an accompanying editorial. Empirically derived dietary patterns, such as those described in this study, can form the basis for recommendations easily, he added. “We usually have greater confidence when interpreting the associations with dietary patterns as causal than we have for the associations with specific nutrients or foods. Furthermore, the findings are particularly useful for making recommendations to a general population because of their use of a baseline coronary heart disease–free study population and the inclusion of black participants with greater susceptibility to heart failure. Thus, this study possesses a great potential of informing the population-level strategies for the prevention of heart failure.”

Nutritional epidemiologic studies examining subtypes of heart failure are valuable in light of the disease’s phenotypic and pathophysiological heterogeneity, Dr. Wang wrote. “These findings, if confirmed in future studies, will not only contribute to in-depth biological understanding and phenotypic refinement of heart failure, but also inform dietary prevention approaches customized for specific heart failure phenotypes. In addition, they perfectly fit into key missions of precision medicine [i.e., understanding large variability between individuals in both the development and the clinical manifestations of the specific disease, as well as variability in individual’s response to dietary, lifestyle, and pharmacological interventions].”

Dr. Wang reported no relationships relevant to the contents of this paper.



Adherence to a plant-based diet is inversely linked with the risk of incident heart failure, according to an analysis published online in the Journal of the American College of Cardiology.

Ron Chapple Studios/

Conversely, a Southern diet, defined as favoring fried and processed foods, is associated with an increased risk of heart failure. The results support a population-based dietary strategy for decreasing the risk of incident heart failure, according to the investigators.

Campaigns to prevent heart failure often emphasize the maintenance of a healthy diet and weight; however, little research has examined the relationship between dietary patterns and incident heart failure in patients without coronary heart disease.

Kyla M. Lara, MD, postgraduate fellow of cardiology and general internal medicine at the Icahn School of Medicine at Mount Sinai, New York, and colleagues sought to analyze the associations between five dietary patterns and incident hospitalizations for heart failure among adults in the United States. They examined data from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) trial, a prospective study of black and white adults who were followed from 2003-2007 to 2014. Eligible participants completed a food frequency questionnaire and had no coronary heart disease or heart failure at baseline.

The REGARDS researchers’ principal component analysis identified the following five dietary patterns: convenience (for example, Mexican and Chinese dishes and fast food), plant based (for example, vegetables, fruit, and fish), sweets (for example, desserts, breads, and candy), Southern (for example, fried food, processed meats, and sugary beverages), and alcohol/salads. Dr. Lara and colleagues chose incident heart failure hospitalization as their primary endpoint.

The investigators included 16,068 participants in their analysis. Mean age was 64 years, roughly 59% of the sample were women, and 34% were black.

After a median 8.7 years of follow-up, 363 participants had incident heart failure hospitalizations. The highest quartile of adherence to the plant-based dietary pattern was associated with a 41% lower risk of heart failure in multivariate models, compared with the lowest quartile. The highest adherence to the Southern dietary pattern was linked with a 72% higher risk of heart failure after adjustments for age, sex, race, and other potential confounders such as education, income, smoking, and physical activity.

After further adjustments for body mass index, waist circumference, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, and chronic kidney disease, the association was attenuated and no longer statistically significant. Dr. Lara and colleagues found no statistically significant associations between incident heart failure with reduced or preserved ejection fraction hospitalizations and the dietary patterns. They also found no associations with the other three dietary patterns.

One researcher reported receiving research funding from Amgen and has consulted for Novartis. The other researchers reported no relevant conflicts.

SOURCE: Lara KM et al. J Am Coll Cardiol. 2019 Apr 30;73(16):2036-45.

Next Article: