Adherence to Plant-Based Diet Inversely Associated With Incident HF Risk

congestive heart failure with pulmonary edema
congestive heart failure with pulmonary edema
Higher adherence to a plant-based diet is associated with a lower risk for incident heart failure hospitalization.

A new study of older US adults confirms the value of a plant-based diet for reducing the risk for incident heart failure (HF). The study also found that a Southern dietary pattern, rich in fried foods and sugar-sweetened beverages, was associated with an increased risk for incident HF hospitalization. The findings were published in the Journal of the American College of Cardiology.

A large cohort of black and white US adults without coronary heart disease or HF (mean age, 64.0±9.1, 58.7% women, 33.6% black, 34.0% residents of the stroke belt) were followed from 2003 to 2007 and through 2014. Participants completed a food frequency questionnaire to identify dietary patterns and the association of these patterns with incident HF hospitalizations. The principle component analysis identified 5 dietary patterns, including convenience, plant-based, sweets, Southern, and alcohol/salads. A total of 16,068 individuals participated in the study.

Participants were categorized into 4 quartiles based on their adherence to each dietary pattern, with quartile 1 (Q1) representing the lowest adherence/consumption and quartile 4 (Q4) representing the highest adherence/consumption.

During a median 8.7-year follow-up, a total of 363 participants had an incident HF hospitalization. In multivariable-adjusted models, Q4 of the plant-based dietary pattern had a significant 41% lower HF risk compared with Q1 of the same pattern (hazard ratio [HR], 0.59; 95% CI, 0.41-0.86; P =.004). The highest adherents to the Southern dietary pattern had a 72% higher HF risk in the adjusted analysis (HR, 1.72; 95% CI, 1.20-2.46; P =.005).

The association between the Q4 in the Southern dietary pattern group and incident HF was no longer significant in analyses that further adjusted for body mass index, waist circumference, hypertension, dyslipidemia, diabetes, atrial fibrillation, and chronic kidney disease. There was also no association between incident HF and the other 3 dietary patterns.

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A limitation of the study included the reliance on self-reported food frequency questionnaires, which are prone to recall error and bias.

Findings from this study possibly “support a population-based dietary strategy for lowering the risk of incident HF.”


Lara KM, Levitan EB, Gutierrez OM, et al. Dietary patterns and incident heart failure in U.S. adults without known coronary disease. J Am Coll Cardiol. 2019;73(16):2036-2045.