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Diet and Clinical Outcomes in a Heart Failure Population

Philip Joseph et al. JACC Heart Fail. .

Abstract

Background: There are limited data to inform dietary recommendations in persons with heart failure (HF).

Objectives: The aim of this study was to examine associations between consumption levels of 11 common foods, and a healthy diet pattern, with clinical outcomes in a HF population.

Methods: This analysis was a substudy of 3,798 participants from 25 countries enrolled in the multinational G-CHF (Global Congestive Heart Failure) registry with dietary data collected through food frequency questionnaires. Associations were examined between consumption levels of 6 plant-based foods (fruits, vegetables, legumes, nuts, whole grains, and refined grains) and 5 animal-based foods (fish, poultry, unprocessed red meat, eggs, and dairy) with the primary composite outcome of death or HF hospitalization and its components. Also examined was the association between an overall healthy diet pattern (measured by using a mAHEI [modified Alternative Heathy Eating Index]) and these outcomes.

Results: A total of 1,236 participants had a primary outcome event, 890 participants died, and 593 were hospitalized for HF. Higher legume intake (HR: 0.85 [95% CI: 0.73-0.99] for 0.1 to <0.5 serving per day and HR: 0.80 [95% CI: 0.65-0.98] for ≥0.5 serving per day vs <0.1 serving per day) was associated with a lower risk of the primary outcome. Moderate vegetable intake (1 to <3 servings per day) was associated with a lower risk of HF hospitalization (HR: 0.77 [95% CI: 0.61-0.97]) compared with <1 serving per day. Higher refined grain intake was associated with a higher risk of hospitalization for HF (HR: 1.56 [95% CI: 1.19-2.05] for 1-3 servings per day and HR: 1.76 [95% CI: 1.30-2.39) for >3 servings per day vs <1 serving per day). Associations with other foods, as well as with the mAHEI, were neutral.

Conclusions: In persons with HF, higher legume and vegetable intake were each associated with a lower risk of adverse clinical outcomes, whereas higher refined grain intake was associated with a higher risk of adverse clinical outcomes.

Keywords: clinical outcomes; diet; heart failure; registry.

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Conflict of interest statement

Funding Support and Author Disclosures The G-CHF study is funded by an unrestricted grant from Bayer AG. Dr Joseph is supported by a McMaster University Mid-Career Investigator Award. Dr Avezum has received presentation honoraria from Novartis. Dr Bayes-Genis has received grants or contracts from AstraZeneca, Bristol Myers Squibb/Pfizer, Sanofi-Aventis, Eisai, Novartis, GlaxoSmithKline, Amgen, Novo Nordisk, and Bayer; consulting fees from AstraZeneca, Bristol Myers Squibb/Pfizer, Sanofi Aventis, GlaxoSmithKline, and Bayer; presentation honoraria from AstraZeneca, Sanofi-Aventis, Novartis, GlaxoSmithKline, Bristol Myers Squibb, and Bayer; travel funding from AstraZeneca, Bristol Myers Squibb, Sanofi Aventis, and Bayer; and is a member of data safety monitoring boards or advisory boards for AstraZeneca, Bristol Myers Squibb, Sanofi Aventis, GlaxoSmithKline, and Bayer. Dr Maggioni has received honoraria for study committee participation from AstraZeneca, Novartis, Bayer, and Sanofi. Dr Ertl has received grants or contracts and consulting fees from Novartis; and is an advisory board member of the General Secretary of the German Society of Internal Medicine. Dr Lund has received grants or contracts from AstraZeneca, Vifor Pharma, Novartis, Boston Scientific, and Boehringer Ingelheim; consulting fees from Merck, Vifor Pharma, AstraZeneca, Bayer, Pharmacosmos, Medscape, Sanofi, Lexicon, MyoKardia, Boehringer Ingelheim, and Servier; presentation honoraria from Abbott, Medscape, Radcliffe, AstraZeneca, Novartis, Bayer, TMA Academy, Boehringer Ingelheim, and Orion Pharma; is an advisory board member of the Heart Failure Association of the ESC, and the European Society of Cardiology, Swedish Society of Cardiology, HF Working Group; and holds stock in AnaCardio. Dr Pogosova has received grants or contracts from BMS–AXIOMATIC-SSP and presentation honoraria from Bayer; and is a board member of the Russian National Society of Preventive Cardiology. Dr Yusuf has received honoraria and travel expenses from Bayer, AstraZeneca and Boehringer Ingelheim in the last 5 years. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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