COMMENTARY

Heart Failure: Can the Mediterranean and DASH Diets Reduce Mortality?

JoAnn E. Manson, MD, DrPH

Disclosures

January 30, 2014

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Hello. This is Dr. JoAnn Manson, Professor of Medicine at Harvard Medical School and Brigham and Women's Hospital. I would like to talk with you today about the role of diet and dietary patterns, such as the Mediterranean diet and the DASH diet, in reducing mortality among patients with heart failure.

Heart failure is a major public health problem, and despite advances in treatment, mortality rates remain high, even above 50% at 5 years. The DASH diet and the Mediterranean diet have been linked to reduced risk for hypertension and cardiovascular events; and the Mediterranean diet, even in randomized clinical trial settings, has been linked to reduced risk for cardiovascular disease and diabetes.

Surprisingly, there has been very little research on the relationship between dietary patterns and risk for mortality, either all-cause or cardiovascular disease mortality, among patients with heart failure.

The DASH diet and Mediterranean diet have several components in common, including higher intake of fruits and vegetables, whole grains, and nuts, and lower intake of red meats and processed foods.

We are interested in looking at the relationship between dietary patterns and mortality among patients with heart failure in the Women's Health Initiative. We published the findings in Circulation: Heart Failure[1] a couple of months ago, with Emily Levitan as first author. Among more than 3200 women with heart failure in the Women's Health Initiative, there were 1400 deaths over a median of 4.6 years of follow-up; approximately 43% of the women who were hospitalized for heart failure died during that period. Detailed assessments of diet were obtained using food frequency questionnaires before the heart failure hospitalizations. This was an observational study, not a randomized clinical trial.

Looking at the relationship between calculated dietary pattern scores for DASH and for Mediterranean diets, there was a significant inverse relationship between the DASH diet score and mortality in this population. The women who were in the highest quartile of the DASH diet score had about a 16% reduction in the risk for mortality. For the Mediterranean diet there was also an inverse trend. It was not quite statistically significant, but for the women in the highest quartile of the Mediterranean diet, there was about a 15% lower risk for mortality.

These findings were present after adjusting for a large number of lifestyle and behavioral factors, and they were true for women whether or not they had a history of a previous coronary heart disease event.

Overall these results were promising. When we looked at the individual components of the diet scores, it was very interesting that in both diets there was a significant inverse relationship between intake of vegetables, whole grains, and nuts and reduced risk for mortality among these women with a history of hospitalization for heart failure.

Overall, more research and randomized clinical trials of dietary interventions in preventing cardiovascular and all-cause mortality among patients with heart failure would be warranted. In the meantime, if you want to recommend a change in diet or dietary patterns for patients with heart failure, it is possible to find recipes online. The American Heart Association Website has recipes related to these diets and many other recipes, which can be found by searching for "Mediterranean diet" and "DASH diet." Recipes also can be found in many cookbooks.

Thank you very much for your attention. This is JoAnn Manson.

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