Abstract
Background and aimsIt is still unclear whether a healthy diet can prevent heart failure (HF). Therefore, this study aimed to investigate the association between adherence to a Mediterranean-style diet, reflected by modified Mediterranean Diet Scores (mMDS), and the incidence of HF in men and women. Methods and resultsThis observational study comprised 9316 men and 27,645 women from the EPIC-NL cohort free from cardiovascular disease at baseline. Dietary intakes were assessed using a validated food frequency questionnaire. mMDS was calculated using a 9-point scale based on consumption of vegetables, legumes, fruit, nuts, seeds, grains, fish, fat ratio, dairy, meat and alcohol. HF events were ascertained by linkage to nation-wide registries. Multivariable Hazard Ratios (HR) and 95% confidence intervals (CI) were estimated by Cox proportional hazards regression models.Over a median follow-up of 15 years (IQR 14–16), 633 HF events occurred: 144 in men (1.5%) and 489 in women (1.8%). The median mMDS was 4 (IQR 3–5). There was significant effect modification by sex (P-value for interaction <0.001), therefore results are stratified for men and women. For men, a higher mMDS associated with lower HF risk (HR: 0.88; 95% CI: 0.79, 0.98 per point increase in mMDS; HR upper category: 0.53; 95% CI: 0.33, 0.86), whereas no association was found in women (HR: 0.98; 95% CI: 0.93, 1.04 per point increase; HR upper category: 1.07; 95% CI: 0.83, 1.36). ConclusionAdherence to a Mediterranean-style diet may reduce HF risk, particularly in men. The underlying reasons for the differences in findings between men and women need further study.
Highlights
Heart failure (HF) is considered to be a major public health issue, because of its high prevalence, and related high rates of mortality and healthcare costs [1].heart failure (HF) is defined as an abnormality of cardiac structure or function [2]
Our study shows that higher adherence to a Mediterraneanstyle diet, as indicated by a relatively higher modified Mediterranean Diet Scores (mMDS), was not associated with risk of HF in women, and with a 12% lower risk per point increment in mMDS in men
Reduced risk of HF per point increment in the modified MDS [8]
Summary
Heart failure (HF) is considered to be a major public health issue, because of its high prevalence, and related high rates of mortality and healthcare costs [1].HF is defined as an abnormality of cardiac structure or function [2]. In HF with preserved ejection fraction (HFpEF) is the diastolic function impaired. HFpEF is most common in women, with hypertension as the most important risk factor, followed by obesity and diabetes. In HF with reduced ejection fraction (HFrEF) is the systolic function impaired, due to hypertrophy [2]. HFrEF is most common in men, especially for those who have a history of smoking or myocardial infarction (MI) [3]. It is still unclear whether a healthy diet can prevent heart failure (HF). This study aimed to investigate the association between adherence to a Mediterranean-style diet, reflected by modified Mediterranean Diet Scores (mMDS), and the incidence of HF in men and women. Multivariable Hazard Ratios (HR) and 95% confidence intervals (CI) were estimated by Cox proportional hazards regression models
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