Heart failure: Diet rich in plant-based foods may help decrease risk

Heart failure happens when the heart cannot pump adequate amounts of blood to the body. Heart failure can lead to fluid buildup in the body, liver and kidney damage, and even to other severe heart conditions.

Certain risk factors can increase someone’s chances of developing heart failure. These include having diabetes, high blood pressure, or a previous heart attack. Lifestyle choices, such as smoking and low physical activity, can also increase risk.

It can be a struggle to manage heart failure, but some medications and lifestyle changes can help. For example, losing weight, limiting alcohol, and decreasing salt intake may help.

Majid Basit, MD, a cardiologist with Memorial Hermann in Houston, not involved in the current research, noted to Medical News Today that heart failure can have a severe impact on a person’s life:

“Heart failure affects 6.7 million Americans over the age of 20. Almost 25% of Americans will develop heart failure sometime in their life. This condition limits a person’s ability to perform simple chores like walking to the mailbox. It can also lead to frequent hospitalization and even death. We are spending close to $60 billion dollars treating heart failure annually.”

Because of the significant burden of heart failure, preventing it when possible is a positive step toward healthier individuals and communities. As the authors of this study note, dietary changes are one intervention that may help limit the number of heart failure cases.

This particular study was a Swedish population-based cohort study and included 23,260 participants. Researchers excluded participants who had a history of other heart-related health events, stroke, previous heart failure, or cancer at baseline.

The average age of participants was just under 58. The median follow-up time was 25 years, allowing for adequate examination of long-term health outcomes.

Researchers looked at participant adherence to the EAT-Lancet dietary index.

The EAT-Lancet diet focuses on plant-based food sources but focuses more on components like legumes and cereals than the Mediterranean diet. However, it still encourages a good intake of fruits and vegetables. It also does not remove animal food sources — it only limits them, and reduces foods with high amounts of sugar.

Registered dietitian nutritionist Karen Z. Berg, MS, RD, who was not involved in the study, further explained to MNT:

“The EAT-Lancet diet focuses a lot on plant-based foods, but it’s not necessarily a fully vegan or vegetarian diet. It emphasizes whole grains, fruits, vegetables, fish, legumes, nuts and unsaturated oils while limiting potatoes, dairy, beef, lamb, pork, poultry, eggs, and added sugar. A lot of the food items that are limited on this diet have long been known to have a considerable effect on heart disease and heart failure.”

Based on participants’ dietary assessments, researchers divided them into five groups, depending on how closely they adhered to the EAT-Lancet diet index. Researchers ran three different analysis models, accounting for different covariates like age, sex, and total energy intake.

During the study, 1,768 participants developed heart failure.

Overall, researchers found that increased adherence to the EAT-Lancet dietary index was associated with a decreased risk for heart failure.

When looking at individual diet components, researchers found that eating more fruit and unsaturated oils was associated with a reduced risk for heart failure, and that moderate dairy intake at baseline was associated with a lower risk for heart failure compared to high dairy intake.

Berg noted that “[i]t’s interesting […] that fruit intake and unsaturated oil intake seemed to have the most positive effects on reducing occurrence of heart failure.”

“Fruits are loaded with phytonutritients, vitamins, minerals and antioxidants, so this is another good reason to ‘eat the rainbow’,” she told us. “Unsaturated oils have your so-called ‘healthy fats,’ and this study further demonstrates the protective effect of omega-3s and omega-6s. Foods that are high in unsaturated fats include olive oil, nuts, seeds and fish.”

Researchers were also able to examine certain plasma proteins in 4,742 participants. They examined how these proteins were associated with risk for heart failure and the EAT-Lancet diet index.

Ultimately, they identified eight plasma proteins related to both components. They noted that these proteins “provide information on potential pathways mediating such an association,” meaning the association between the EAT-Lancet diet and heart failure.

“This study looked at the EAT-Lancet diet, which promotes eating healthy foods like whole grains, vegetables, fruits, and fish and avoiding foods like red meat, saturated fat, and added sugar. A diet like this will bring positive health benefits, including lower blood pressure, cholesterol reduction, and a more ideal body weight. The study showed that a healthy diet leads to fewer cases of heart failure,” Basit commented.

Despite the actionable and encouraging findings of the recent study, it is also critical to acknowledge its limitations.

First, the authors note that they only collected one baseline dietary measurement. This means they could not capture how participants’ dietary intake may have changed during the follow-up time. Some data also relied on participant reporting, which may have affected results.

Second, researchers may not have looked at all the critical plasma proteins related to the EAT-Lancet diet, so future research may be able to expand in this area.

The study was also observational, meaning it cannot establish causation. Researchers further acknowledge the risk for residual confounding and that the study population was predominantly white. Future studies should include other population groups to verify this link between diet and heart failure risk in different populations.

As research moves forward to confirm the best possible diets to prevent heart failure, doctors can assist their patients in implementing food choices that are the most beneficial for heart health.

As Cheng-Han Chen, MD, a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, not involved in the research, noted: “This study adds to many other previous studies which have linked a healthy plant-based diet to improved cardiovascular outcomes. Future research should focus on identifying techniques to promote the uptake of heart-healthy diets in the general population.”