Author + information
- Received August 9, 2018
- Revision received December 20, 2018
- Accepted January 22, 2019
- Published online April 22, 2019.
- Kyla M. Lara, MD, MSa,∗ (, )@kyla_lara,
- Emily B. Levitan, ScDb,
- Orlando M. Gutierrez, MD, MMScc,
- James M. Shikany, DrPH, PA-Cd,
- Monika M. Safford, MDe,
- Suzanne E. Judd, PhDf and
- Robert S. Rosenson, MDg
- aIcahn School of Medicine at Mount Sinai, New York, New York
- bDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- cDepartment of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- dDivision of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- eDivision of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
- fDepartment of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
- gMount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Kyla M. Lara, Department of Cardiovascular Disease, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Background Dietary patterns and associations with incident heart failure (HF) are not well established in the United States.
Objectives The purpose of this study was to determine associations of 5 dietary patterns with incident HF hospitalizations among U.S. adults.
Methods The REGARDS (REasons for Geographic and Racial Differences in Stroke) trial is a prospective cohort of black and white adults followed from 2003 to 2007 through 2014. Inclusion criteria included completion of a food frequency questionnaire and no baseline coronary heart disease or HF. Five dietary patterns (convenience, plant-based, sweets, Southern, and alcohol/salads) were derived from principal component analysis. The primary endpoint was incident HF hospitalization.
Results This study included 16,068 participants (mean age 64.0 ± 9.1 years, 58.7% women, 33.6% black participants, 34.0% residents of the stroke belt). After a median of 8.7 years of follow-up, 363 participants had incident HF hospitalizations. Compared with the lowest quartile, the highest quartile of adherence to the plant-based dietary pattern was associated with a 41% lower risk of HF in multivariable-adjusted models (hazard ratio: 0.59; 95% confidence interval: 0.41 to 0.86; p = 0.004). Highest adherence to the Southern dietary pattern was associated with a 72% higher risk of HF 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; hazard ratio: 1.72; 95% confidence interval: 1.20 to 2.46; p = 0.005). However, the association was attenuated and no longer statistically significant after further adjusting for body mass index in kg/m2, waist circumference, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, and chronic kidney disease. No statistically significant associations were observed with incident HF with reduced or preserved ejection fraction hospitalizations and the dietary patterns. No associations were observed with the other 3 dietary patterns.
Conclusions 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.
This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Services. Additional support was provided by R01 HL80477 from the National Heart, Lung, and Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis or interpretation of the data. Dr. Levitan has received research funding from and served on the advisory board for Amgen; and has performed scientific consulting for a research project sponsored by Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Walter C. Willett, MD, served as the Guest Editor for this paper.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received August 9, 2018.
- Revision received December 20, 2018.
- Accepted January 22, 2019.
- 2019 American College of Cardiology Foundation
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