Plant-based diets are associated with a lower risk of heart failure in adults without known heart disease, while Southern diets consisting of more fried and processed foods and sweetened drinks are associated with greater risk, according to a study published in the Journal of the American College of Cardiology ((2019; 73, [16], April 30). The study looked at the association between five dietary patterns and risk of heart failure.

Heart failure prevention strategies currently emphasize quitting smoking, managing high blood pressure and maintaining a healthy diet and weight to prevent heart disease, but research is limited on dietary patterns and incident heart failure in patients without heart disease.

Researchers in this study looked at five major dietary patterns that were identified within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study population. The research team then examined the associations between those patterns and incident heart failure hospitalizations in REGARDS participants without known heart disease or heart failure at baseline. Within the REGARDS study, researchers narrowed their sample size to 16,608 black and white adults age 45 and older.

Participants were sent a 150-question survey based on 107 food items, which were categorized into the five predetermined diets:

  • “convenience” (heavily meat dishes, pasta, Mexican dishes, pizza and fast food)
  • “plant-based” (vegetables, fruit, beans and fish)
  • “sweets/fats” (heavy on desserts, bread, sweet breakfast foods, chocolate and other sugar)
  • “Southern” (heavy on fried food, processed meats, eggs, added fats and sugar-sweetened beverages)
  • “alcohol/salads” (heavy on wine, liquor, beer, leafy greens and salad dressing)

In the follow-up period, which averaged 8.7 years, there were 363 new heart failure hospitalizations. Researchers saw a 41% lower risk of new heart failure hospitalization for participants who adhered most closely to the plant-based diet, compared with those who adhered to it the least.

The highest adherence to the Southern diet was associated with a 72% higher risk of heart failure hospitalization. However, when the Southern diet was adjusted for body mass index, waist circumference, hypertension, dyslipidemia and other factors, the association was no longer statistically significant. Researchers said this could mean that the Southern dietary pattern could increase heart failure risk through factors such as obesity and excess abdominal fat, among other adjusting factors.

Researchers found no statistically significant associations among the remaining dietary patterns and risk of heart failure.

“The need for population based preventive strategies for heart failure is critical,” said Kyla Lara, MD, lead author of the study and a cardiology fellow at Mayo Clinic in Rochester, Minnesota. “These findings support a population-based dietary strategy for lowering the risk of incident heart failure.”

One of the study’s major strengths was the large, diverse sample size, which included people from all demographics and socioeconomic backgrounds. Limitations included potential misclassifications from inaccurate dietary intake reporting and, since diet was assessed only at the beginning of the study, dietary changes may have occurred after the initial assessment.


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