Plant-based diet linked to lower risk of heart failure

Author: Louise Prime

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Adults who ate plant-based diets were less likely to develop heart failure whereas those consuming more fried and processed foods and sweetened drinks were at greatly increased risk, research has shown. The authors of the study*, published in the Journal of the American College of Cardiology, said their findings support a population-based dietary strategy for lowering the risk of incident heart failure.

In the REGARDS (REasons for Geographic and Racial Differences in Stroke) trial, a prospective cohort of 16,068 black and white men and women (mean age 64 years) were followed from 2003 to 2007 until 2014. The research team compared rates of incident heart failure among adults without coronary heart disease, between people who at baseline were following different dietary patterns: ‘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); or ‘alcohol/salads’ (heavy on wine, liquor, beer, leafy greens and salad dressing).

They reported that during a median follow up of 8.9 years, 363 participants were hospitalised for incident heart failure. Their analysis showed that compared with the lowest quartile, the highest quartile of adherence to the plant-based dietary pattern was associated with a 41% lower risk of heart failure (hazard ratio, HR 0.59).

In contrast, after adjusting for age, sex, and race and for other potential confounders (education, income, region of residence, total energy intake, smoking, physical activity, and sodium intake), highest adherence to the Southern dietary pattern was associated with an increased risk of heart failure (HR 1.72). However, the association was attenuated and no longer statistically significant after further adjusting for body mass index in kg/m2, waist circumference, hypertension, dyslipidaemia, diabetes mellitus, atrial fibrillation, and chronic kidney disease.

The researchers added that they found no statistically significant associations with incident heart failure with reduced or preserved ejection fraction hospitalisations and the dietary patterns. No associations were observed with the other three dietary patterns.

They concluded: “Adherence to a plant-based dietary pattern was inversely associated with incident HF risk, whereas the Southern dietary pattern was positively associated with incident HF risk.”

The author of an accompany commentary** called for a prioritisation of heart failure prevention – given how difficult it is to treat, the severe debility that heart failure patients experience and the high cost of heart failure care. He concluded: “This study represents an important step forward in establishing a robust evidence base for the dietary prevention of heart failure.”


*Lara KM, Levitan EB, Gutierrez OM, et al. Dietary patterns and incident heart failure in US adults without known coronary disease. Journal of the American College of Cardiology Apr 2019; 73 (16): 2036-2045; DOI: 10.1016/j.jacc.2019.01.067.

**Wang D. Dietary patterns and precision prevention of heart failure. Journal of the American College of Cardiology Apr 2019;, 73 (16): 2046-2048; DOI: 10.1016/j.jacc.2019.02.037

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