Dietary factors and risk of heart failure: A systematic review

Circulating vitamin E and cardiometabolic measures: a Mendelian randomization analysis

Although a large body of literature reported that high intake of vitamin E played a possible role in reducing risk of cardiometabolic diseases, conflicting results were also found in some observational studies due to confounding factors. Hence, we used a Mendelian randomization study as an alternative way to examine the causality between circulating vitamin E and cardiometabolic diseases. Summary-level data were extracted from consortia and three single nucleotide polymorphisms were used as instrumental variables. Our study showed that a one-SD increase in circulating vitamin E levels was causally associated with an increased risk of coronary artery disease [odds ratio (OR) 3.16 (95%CI 1.74, 5.73); p = 1.91 × 10^-3] at the Bonferroni-adjusted level of significance (p<0.005). Moreover, a one-SD increase in circulating vitamin E levels was associated with a 0.572-SD increase in low density lipoprotein cholesterol (mg/dl), a 0.693-SD increase in total cholesterol (mg/dl), and a 1.45-SD increase in triglyceride (mg/dl), but a 0.502-SD decrease in high density lipoprotein cholesterol (mg/dl) at the Bonferroni-adjusted level of significance (p<0.0028). Our findings indicated that genetically elevated vitamin E was associated with increased risk of coronary artery disease, suggesting an adverse causality between circulating vitamin E and coronary artery disease.

Modifiable Healthy Lifestyle Behaviors: 10-Year Health Outcomes From a Health Promotion Program

INTRODUCTION

Previous studies have examined the impact of healthy lifestyle choices on health-related outcomes; however, given their fragmented, often cross-sectional nature, assessing the relative impact of daily modifiable behaviors on overall long-term outcomes, particularly for a diverse working adult population, remains challenging.

METHODS

Relationships between ten self-reported healthy lifestyle behaviors and health outcomes during the subsequent 9 years in a cohort of 10,248 participants enrolled during 2003 in a voluntary workplace wellness program were assessed. Cox proportional-hazards models computed hazard ratios (HRs) for lifestyle characteristics associated with time to one of seven self-reported chronic diseases or death. Data were collected between 2003 and 2012 and analyzed between 2014 and 2016.

RESULTS

Behaviors that most significantly affected future outcomes were low-fat diet, aerobic exercise, nonsmoking, and adequate sleep. A dose-response effect was seen between dietary fat intake and hypertension, obesity, diabetes, heart disease, and hypercholesterolemia. After dietary fat intake, aerobic exercise was the next most significant behavior associated with development of outcomes. Compared with sedentary participants, those who exercised 4 days per week were less likely to develop new-onset diabetes (HR=0.31, 95% CI=0.20, 0.48); heart disease (HR=0.46, 95% CI=0.27, 0.80); and hypercholesterolemia (HR=0.61, 95% CI=0.50, 0.74). Low-fat diet and adequate sleep were more significant than commonly promoted healthy behaviors, such as eating a daily breakfast.

CONCLUSIONS

Modifiable lifestyle behaviors targeted in health promotion programs should be prioritized in an evidence-based manner. Top priorities for workplace health promotion should include low-fat diet, aerobic exercise, nonsmoking, and adequate sleep.

Nut consumption and risk of heart failure in the Physicians' Health Study I

BACKGROUND

Heart failure is highly prevalent among older adults and is associated with high cost and societal burden. Although previous studies have reported beneficial effects of dietary factors on heart failure predictors, no previous study has examined whether frequent consumption of nuts is associated with a lower risk of heart failure in a large prospective cohort.

OBJECTIVE

We examined the association between nut consumption and incident heart failure to determine whether such a relation is modified by overweight or obesity.

DESIGN

This was a prospective cohort study of 20,976 participants from the Physicians' Health Study I. Nut consumption was assessed with a simple abbreviated food questionnaire, and self-reported heart failure was ascertained by follow-up questionnaires. We used Cox regression to estimate relative risks of heart failure.

RESULTS

After an average follow-up of 19.6 y, 1,093 new cases of heart failure occurred. Nut consumption was not associated with the risk of developing heart failure in this cohort: multivariable adjusted hazard ratios were 1.0 (reference), 0.98 (95% CI: 0.83, 1.15), 1.06 (95% CI: 0.89, 1.27), and 1.01 (95% CI: 0.84, 1.22) for nut consumption of <1, 1, and > or =2 servings/wk, respectively (P for linear trend: 0.64). The lack of a meaningful relation between nut intake and incident heart failure was seen in both lean and overweight or obese participants (P for interaction: 0.96).

CONCLUSION

Our data do not provide evidence for an association between nut consumption and incident heart failure in US male physicians. However, our data cannot rule out possible benefits of nut consumption on subtypes of heart failure not prevalent in this cohort.