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heart failure

The DASH diet is a flexible eating plan that helps create a heart-healthy eating style for life. Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

Heart failure (HF) occurs when the heart’s pumping is not able to keep up with the body’s demands for blood and oxygen and may decompensate. Unlike a heart attack, it develops slowly over years and may take a long time to become symptomatic. According to the latest statistics, 6.7 million Americans over the age of 19 are affected (1).  These numbers are projected to increase to 8.7 million by 2030, with the greatest growth among those aged 35 to 64 (2).

There are two types of heart failure, systolic and diastolic. Put simply, the difference is that the output of blood with each contraction of the heart’s left ventricle is generally preserved in diastolic HF, while it can be significantly reduced in systolic HF.

Fortunately, both types can be diagnosed with an echocardiogram, an ultrasound of the heart. The signs and symptoms of both include shortness of breath during daily activities or when lying down; edema or swelling in the feet, legs, ankles or stomach, reduced exercise tolerance; and feeling tired or weak. These can have a significant impact on your quality of life.

Major lifestyle risk factors for heart failure include obesity, smoking, poor diet, being sedentary, excessive alcohol intake (3). Medical conditions that increase your risk include diabetes, coronary artery disease, high blood pressure, and valvular heart disease.

Heart failure can be treated with medication, including blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. All of these have side effects. We are going to look at recent studies that examine the role of diet in reducing your risk. 

The role of antioxidants in your diet

If we look beyond the risk factors mentioned above, some studies have explored the role oxidative stress may play an important role in contributing to HF.

In an analysis of the Swedish Mammography Cohort, researchers showed that a diet rich in antioxidants reduces the risk of developing HF (4). In the group that consumed the most nutrient-dense foods, there was a significant 42 percent reduction in the development of HF, compared to the group that consumed the least. The antioxidants were mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for most of the effect.

This study was the first to investigate the impact of dietary antioxidants on heart failure prevention.

This was a large study: it involved 33,713 women with 11.3 years of follow-up. Still, there are limitations, because it was an observational study, and the population involved only women. However, the results are very exciting, and there is little downside to applying this approach.

Applying the DASH diet

A 2022 study examined the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on the risk of developing HF (5). This study included over 76,000 men and women, ages 45-83 and without previous HF, ischemic heart disease or cancer from the Cohort of Swedish Men and the Swedish Mammography Cohort.

The DASH diet emphasizes consuming fruit, vegetables, whole grains, nuts and legumes, and low-fat dairy and de-emphasizes red and processed meat, sugar-sweetened beverages, and sodium.

The researchers found that long-term adherence to the DASH diet was associated with a lower risk of HF. The greater the participants’ adherence, the greater the positive effect.

Interestingly, even replacing one serving per day of red and processed meat with one serving per day of other DASH diet foods was associated with an approximate 10 percent lower risk of HF.

Comparing a variety of diets

The REGARDS (REasons for Geographic and Racial Differences in Stroke) Trial examined the impact of five dietary patterns on later development of HF in over 16,000 patients followed for a median of 8.7 years. The dietary patterns included convenience, plant-based, sweets, Southern, and alcohol/salads (6). 

Researchers found that a plant-based dietary pattern was associated with a significantly lower risk of HF. Compared with the lowest quartile, the highest quartile of adherence to the plant-based dietary pattern was associated with a 41 percent lower risk of HF. 

The highest adherence to the Southern dietary pattern was associated with a 72 percent higher risk of HF after adjusting for age, sex, and race and for other potential confounding factors. Researchers found less effect after further adjusting for body mass index, waist circumference, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, and chronic kidney disease.

They did not observe any associations with the other 3 dietary patterns.

These studies suggest that we should seek to prevent heart failure with dietary changes, including consuming higher amounts of antioxidant-rich foods, such as fruits and vegetables, and lower amounts of red and processed meats.

References:

(1) Circulation. 2024;149:e347–913. (2) hfsa.org. (3) cdc.gov. (4) Am J Med. 2013 Jun:126(6):494-500. (5) Eur J of Prev Cardiology 2022 May: 29(7): 1114–1123. (6) J Am Coll Cardiol. 2019 Apr 30; 73(16): 2036–2045.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Photo courtesy of Stony Brook Medicine

Stony Brook Medicine (SBM) has once again been recognized by the American Heart Association for its commitment to delivering high-quality patient care across cardiovascular and stroke focus areas. This year marks the 14th consecutive year for Stony Brook University Hospital (SBUH) (2010 – 2024) and the 11th consecutive year forStony Brook Southampton Hospital (SBSH) (2014 – 2024) to receive the Association’s Get With The Guidelines® – StrokeGold Plus achievement award. For the sixth consecutive year, SBUH received the Get With The Guidelines® – Heart FailureGold Plus quality achievement award. Both awards recognize SBM’s dedication to improving outcomes for patients, meaning reduced readmissions and more healthy days at home.

“This recognition by the American Heart Association underscores the unwavering dedication of our healthcare teams to provide exceptional care for our patients,” said Dr. William Wertheim, Executive Vice President of Stony Brook Medicine. “Our continuous recognition over the years highlights our dedication to providing top-tier cardiovascular and stroke care, and we are proud to see the positive impact our efforts have on improving patient outcomes.”

Stroke

Stroke is the No. 5 cause of death and a leading cause of disability in the U.S. Early stroke detection and treatment are key to improving survival, minimizing disability and accelerating recovery times. Get With The Guidelines puts the expertise of the American Heart Association and American Stroke Association to work for hospitals nationwide, helping ensure patient care is aligned with the latest research- and evidence-based guidelines.

In addition to this year’s Gold Plus achievement, Stony Brook University Hospital once again earned the distinctions of Target: Stroke℠ Elite Honor Roll, Target: Stroke Advanced Therapy Honor Roll and Target: Type 2 Diabetes℠ Honor Roll for Stony Brook University Hospital.

Heart Failure

Approximately 6 million U.S. adults live with heart failure, a condition that impairs the heart’s ability to pump blood effectively throughout the body. This can significantly impact a person’s quality of life, causing symptoms such as shortness of breath and fatigue which is often severe. However, with advanced care, patients can often achieve a better quality of life through lifestyle changes, symptom monitoring, accurate diagnosis, and cutting-edge therapies including state-of-the-art medications and interventions.

The Heart Failure and Cardiomyopathy Center at Stony Brook continues to be recognized for its excellence in patient care, having earned the American Heart Association’s Get With The Guidelines® – Heart Failure Gold Plus quality achievement award for the sixth consecutive year. This prestigious honor commends hospitals that consistently demonstrate an unwavering commitment to treating patients according to the latest evidence-based guidelines from the American Heart Association. The award further highlights Stony Brook’s Heart Failure and Cardiomyopathy Center’s recognition as Long Island’s only heart failure program to have earned the distinguished Joint Commission Certification for Advanced Heart Failure, a mark of excellence the Center has proudly achieved since 2011. At Stony Brook, the comprehensive heart failure program leverages the most advanced pharmacological therapies, surgical interventions, and breakthrough devices to ensure the highest quality of life for its patients.

Resuscitation

Each year, more than 300,000 adults and children experience an in-hospital cardiac arrest.  Survival from cardiac arrest largely depends on timely medical emergency team response and effective CPR.

Get With The Guidelines – Resuscitation was developed to help save lives of patients who experience in-hospital cardiac arrests by consistently following the most up-to-date research-based guidelines for treatment as outlined by the American Heart Association. Guidelines include following protocols for patient safety, medical emergency team response, effective and timely resuscitation (CPR) and post-resuscitation care.

Stony Brook University Hospital is also nationally recognized for its commitment to improving cardiac arrest survival rates and received these top-level awards:

  • Get With The Guidelines® – Resuscitation Gold – Adult
  • Get With The Guidelines® – Resuscitation Gold – Pediatric
  • Get With The Guidelines® – Resuscitation Gold – Neonate/Infant

 

About Stony Brook University Hospital:

Stony Brook University Hospital (SBUH) is Long Island’s premier academic health center. With 624 beds, SBUH serves as the region’s only tertiary care center and Regional Trauma Center, and is home to the Stony Brook University Heart Institute, Stony Brook University Cancer Center, Stony Brook Children’s Hospital and Stony Brook University Neurosciences Institute. SBUH also encompasses Suffolk County’s only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation’s first Pediatric Multiple Sclerosis Center. To learn more, visit www.stonybrookmedicine.edu/sbuh.

About Stony Brook Southampton Hospital:

With 124 beds, Stony Brook Southampton Hospital (SBSH) is staffed by more than 280 physicians, dentists, and allied health professionals representing 48 medical specialties. A campus of Stony Brook University Hospital, SBSH offers a diverse array of clinical services, ranging from primary medical care to specialized surgical procedures, including cardiac catheterization, orthopedics and bariatrics. The sole provider of emergency care on Long Island’s South Fork, Stony Brook Southampton Hospital is a provisional Level III adult Trauma Center. The hospital includes The Phillips Family Cancer Center, a Heart and Stroke Center, Breast Health Center, The Center for Advanced Wound Healing, Wellness Institute, and 32 satellite care centers throughout the South Fork of Long Island. The hospital is the largest employer on the South Fork with more than 1,200 employees. To learn more, visit www.southampton.stonybrookmedicine.edu.

About Get With The Guidelines:

Get With The Guidelines® is the American Heart Association/American Stroke Association’s hospital-based quality improvement program that provides hospitals with the latest research-based guidelines. Developed with the goal of saving lives and hastening recovery, Get With The Guidelines has touched the lives of more than 14 million patients since 2001. For more information, visit heart.org.

METRO photo
Diet may have a significant impact on heart failure risk and outcomes

By David Dunaief, M.D.

Dr. David Dunaief

Unlike a heart attack, which is acute, heart failure develops slowly and may take years to become symptomatic. Heart failure (HF) occurs when the heart’s pumping is not able to keep up with the body’s demands for blood and oxygen and may decompensate. According to the American Heart Association, over six million Americans are affected, and the numbers are projected to increase significantly by 2030 (1).

There are two types of heart failure, systolic and diastolic. The basic difference is that the ejection fraction, the output of blood with each contraction of the left ventricle of the heart, is more or less preserved in diastolic HF, while it can be significantly reduced in systolic HF.

Fortunately, both types can be diagnosed with the help of an echocardiogram, an ultrasound of the heart. The signs and symptoms of both include shortness of breath on exertion or when lying down, edema or swelling, reduced exercise tolerance, weakness and fatigue. Each of these can impact quality of life significantly.

Major lifestyle risk factors for heart failure include obesity; smoking; poor diet, including consuming too much sodium; being sedentary; and drinking alcohol excessively. Conditions that increase your risk include diabetes, coronary artery disease and high blood pressure.

Typically, heart failure is treated with blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. We are going to look at how diet and iron levels can affect heart failure outcomes.

Can diet improve heart failure?

If we look beyond the usual risk factors mentioned above, oxidative stress may play an important role as a contributor to HF.

In a population-based, prospective study, the Swedish Mammography Cohort, results show that a diet rich in antioxidants reduces the risk of developing HF (2). In the group that consumed the most nutrient-dense foods, there was a significant 42 percent reduction in the development of HF, compared to the group that consumed the least. According to the authors, the antioxidants were derived mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for the majority of the effect.

What makes this study so impressive is that it is the first of its kind to investigate antioxidants from the diet and their impacts on heart failure prevention.

This was a large study, involving 33,713 women, with good duration — follow-up was 11.3 years. There are limitations to this study, because it is observational, and the population involved only women. Still, the results are very exciting, and it is unlikely there is a downside to applying this approach to the population at large.

More recently, the REGARDS (REasons for Geographic and Racial Differences in Stroke) Trial examined the impact of five dietary patterns on later development of HF in over 16,000 patients followed for a median of 8.7 years. 

The dietary patterns included convenience, plant-based, sweets, Southern, and alcohol/salads (3). Researchers found that a plant-based dietary pattern was associated with a significantly lower risk of HF.

Does iron supplementation improve heart failure outcomes?

An observational study that followed 753 heart failure patients for almost two years showed that iron deficiency without anemia increased the risk of mortality in heart failure patients by 42 percent (4).

In this study, iron deficiency was defined as a ferritin level less than 100 μg/L (the storage of iron) or, alternately, transferrin saturation less than 20 percent (the transport of iron) with a ferritin level in the range 100–299 μg/L.

The authors conclude that iron deficiency is potentially more predictive of clinical outcomes than anemia, contributes to the severity of HF and is common in these patients. However, studies of oral iron supplementation has not been shown to improve results, while intravenous supplementation has been shown to reduce hospitalizations and mortality (5).

These studies suggest that we should try to prevent heart failure through dietary changes, including high levels of antioxidants, because it is not easy to reverse the disease. Those with HF should have their ferritin and iron levels checked, because these can be addressed with medical supervision.

References:

(1) Circulation. 2020;141:e139–e596. (2) Am J Med. 2013 Jun:126(6):494-500. (3) J Am Coll Cardiol. 2019 Apr 30; 73(16): 2036–2045. (4) Am Heart J. 2013;165(4):575-582. (5) Eur J Heart Fail. 2018;20(1):125–133.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

Heart failure (HF) occurs when the heart’s pumping is not able to keep up with the body’s demands for blood and oxygen and may decompensate. Unlike a heart attack, which is acute, heart failure is a slowly developing disease that may take years to become symptomatic.

As of 2018, there were about 6.2 million Americans living with heart failure, and heart failure was a potential contributing factor in 13.4 percent of deaths (1).

There are two types of heart failure, systolic and diastolic. The basic difference is that the ejection fraction, the output of blood with each contraction of the left ventricle of the heart, is more or less preserved in diastolic HF, while it can be significantly reduced in systolic HF.

We have more evidence-based medicine, or medical research, on systolic heart failure. Fortunately, both types can be diagnosed with the help of an echocardiogram, an ultrasound of the heart. The signs and symptoms may be similar, as well, and include shortness of breath on exertion or when lying down, edema or swelling, reduced exercise tolerance, weakness and fatigue.

Major lifestyle risk factors for heart failure include obesity; smoking; poor diet, including consuming too much sodium; being sedentary; and drinking alcohol excessively. Pre-existing conditions that are significant risk factors include diabetes, coronary artery disease and high blood pressure.

Typically, heart failure is treated with blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. We are going to look at how diet, iron and the supplement CoQ10 impact heart failure.

Antioxidant diet’s impact

If we look beyond the usual risk factors mentioned above, oxidative stress may play an important role as a contributor to HF. Oxidative stress is thought to result in damage to the inner lining of the blood vessels, or endothelium, oxidation of cholesterol molecules and a decrease in nitric oxide, which helps vasodilate blood vessels.

In a population-based, prospective (forward-looking) study, called the Swedish Mammography Cohort, results show that a diet rich in antioxidants reduces the risk of developing HF (2). In the group that consumed the most nutrient-dense foods, there was a significant 42 percent reduction in the development of HF, compared to the group that consumed the least. According to the authors, the antioxidants were derived mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for the majority of the effect.

This nutrient-dense approach to diet increased oxygen radical absorption capacity. Oxygen radicals have been implicated in cellular and DNA damage, potentially as a result of increasing chronic inflammation. What makes this study so impressive is that it is the first of its kind to investigate antioxidants from the diet and their impacts on heart failure prevention.

This was a large study, involving 33,713 women, with good duration — follow-up was 11.3 years. There are limitations to this study, because it is observational and the population involved only women. Still, the results are very exciting, and it is unlikely there is a downside to applying this approach to the population at large.

CoQ10 benefits

Coenzyme Q10 is a substance produced by the body that helps the mitochondria (the powerhouse of the cell) produce energy. It is thought of as an antioxidant. 

Results of the Q-SYMBIO study, a randomized double-blind control trial, showed an almost 50 percent reduction in the risk of all-cause mortality and 50 percent fewer cardiac events with CoQ10 supplementation (3). This one randomized controlled trial followed 420 patients for two years who had severe heart failure. This involved using 100 mg of CoQ10 three times a day compared to placebo.

The lead author goes as far as to suggest that CoQ10 should be part of the paradigm of treatment. CoQ10 is the first supplement to show survival benefits in heart failure.

This study’s rigor is impressive; it assesses the supplement as if it were a drug. A subsequent 2019 sub-group analysis of Q-SYMBIO confirmed the short- and long-term effects and also found a significant improvement in left ventricular ejection fraction among CoQ10 therapy adherents (4).

A meta-analysis involving 13 studies of CoQ10 supplementation with HF confirmed that CoQ10 resulted in ejection fraction improvements among patients with less severe stages of HF, although the authors suggest that studies with more diverse demographics and that refine and compare dose responses are warranted (5). If you have heart failure, you may want to discuss CoQ10 supplementation with your physician.

Iron deficiency challenges

An observational study that followed 753 heart failure patients for almost two years showed that iron deficiency without anemia increased the risk of mortality in heart failure patients by 42 percent (6).

In this study, iron deficiency was defined as a ferritin level less than 100 μg/L (the storage of iron) or, alternately, transferrin saturation less than 20 percent (the transport of iron) with a ferritin level in the range 100–299 μg/L.

The authors conclude that iron deficiency is potentially more predictive of clinical outcomes than anemia, contributes to the severity of HF and is common in these patients. Thus, it behooves us to try to prevent heart failure through dietary changes, including high levels of antioxidants, because it is not easy to reverse the disease. Those with HF should have their ferritin and iron levels checked, for these are correctable.

Based on study results, CoQ10 appears to be a compelling therapy to reduce risk of further complications and potentially death. Consult with your doctor before taking CoQ10 or any other supplements.

References:

(1) cdc.gov. (2) Am J Med. 2013 Jun:126(6):494-500. (3) JACC Heart Fail. 2014 Dec;2(6):641-649. (4) Cardiol J. 2019;26(2):147-156. (5) Am J Clin Nutr. 2013 Feb; 97(2): 268–275. (6) Am Heart J. 2013;165(4):575-582.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.