Intake of Different Dietary Proteins and Risk of Heart Failure in Men: The Kuopio Ischaemic Heart Disease Risk Factor Study

Abstract

Background: Animal and plant protein intakes have indicated opposite associations with cardiovascular mortality risk. Whether dietary proteins are associated with risk of heart failure (HF) is unclear. Thus, we examined the associations of proteins from different food sources with risk of HF.

Methods and results: The study included 2441 men aged 42 to 60 years at the baseline examinations in 1984 to 1989 in the Kuopio Ischaemic Heart Disease Risk Factor Study. Protein intakes at baseline were assessed with 4-day dietary records. Data on incident HF cases were obtained from national registers. HF risk according to protein intake was estimated by Cox proportional hazard ratios. During the mean follow-up of 22.2 years, 334 incident HF cases occurred. Higher intake of total protein indicated a trend toward increased risk of HF (multivariable-adjusted hazard ratio in the highest versus lowest quartile=1.33; 95% confidence interval: 0.95-1.85; P-trend=0.05). The associations between specific types and sources of protein with incident HF were consistent with this overall finding although not all associations reached statistical significance. For example, the hazard ratio in the highest versus lowest quartile was 1.43 (95% confidence interval: 1.00-2.03; P-trend=0.07) for total animal protein and 1.17 (95% confidence interval: 0.72-1.91; P-trend=0.35) for total plant protein.

Conclusions: In middle-aged men, higher protein intake was marginally associated with increased risk of HF.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03221127.

Keywords: calcium; dietary proteins; heart failure; men; prospective studies.

Figure.

Multivariable-adjusted hazard ratios of total protein intake with risk of heart failure in 2441 men, evaluated by restricted cubic splines from Cox proportional hazards models. The model was adjusted for age (y), examination year, energy intake (kcal/d), education (y), income (euros/y), pack-years of smoking (packs smoked per day×years smoked), alcohol intake (g/wk), leisure-time physical activity (kcal/d), body mass index (kg/m²), family history of coronary heart disease (yes/no), diseases (coronary heart diseases or use of cardiac medications, diabetes mellitus, or hypertension) at the baseline and during the follow-up, and intakes of saturated (g/d), monounsaturated (g/d), polyunsaturated (g/d), and trans fatty acids (g/d) and fiber (g/d). The solid lines represent the central risk estimates, and the shades are the 95% confidence interval, relative to the reference level (12.5th percentile). The dotted vertical lines correspond to 10th, 25th, 50th, 75th, and 90th percentile of the total protein intake.