Razavi Alexander C, Bazzano Lydia A, He Jiang, Whelton Seamus P, Fernandez Camilo, Ley Sylvia, Qi Lu, Krousel-Wood Marie, Harlan Timothy S, Kelly Tanika N
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
ESC Heart Fail. 2020 Oct;7(5):2700-2710. doi: 10.1002/ehf2.12859. Epub 2020 Jul 10.
Left ventricular diastolic dysfunction (LVDD) is an early heart failure with preserved ejection fraction (HFpEF) phenotype that is reversible. Identifying dietary predictors associated with LVDD in diverse populations may help broadly improve HFpEF primary prevention.
This longitudinal analysis included 456 individuals of the Bogalusa Heart Study (27% Black, 63% women, baseline age = 36.1 ± 4.4 years). Diet was measured at baseline through food frequency questionnaires. LVDD was defined at follow-up (median = 12.9 years) through echocardiographic measurement of the E/A ratio, E/e' ratio, isovolumic relaxation time, and deceleration time. Multivariable-adjusted logistic regression estimated the risk of LVDD according to dietary predictor, adjusting for traditional cardiovascular disease risk factors. Compared with the lowest tertile, participants in the middle tertile of total protein (OR = 3.30, 95% CI: 1.46, 7.45) and animal protein (OR = 2.91, 95% CI: 1.34, 6.34) consumption experienced the highest risk of LVDD. There was a 77% and 56% lower risk of LVDD for persons in the middle vs. lowest tertile of vegetable (OR = 0.23, 95% CI: 0.11, 0.49) and legume consumption (OR = 0.44, 95% CI: 0.22, 0.85), respectively. Total protein, animal protein, processed meat, and egg consumption indicated a quadratic trend towards increased risk of LVDD, while legume and vegetable intake conferred a quadratic trend towards decreased risk of LVDD (all quadratic P < 0.05).
Diets higher in animal foods and lower in plant foods are associated with an increased risk for LVDD. These findings suggest threshold effects of diet on LVDD, past which more traditional cardiometabolic determinants occupy a larger role in HFpEF risk.
左心室舒张功能障碍（LVDD）是射血分数保留的心衰（HFpEF）的一种早期且可逆的表型。确定不同人群中与LVDD相关的饮食预测因素可能有助于广泛改善HFpEF的一级预防。
这项纵向分析纳入了博加卢萨心脏研究中的456名个体（27%为黑人，63%为女性，基线年龄 = 36.1 ± 4.4岁）。通过食物频率问卷在基线时测量饮食情况。在随访时（中位数 = 12.9年）通过超声心动图测量E/A比值、E/e'比值、等容舒张时间和减速时间来定义LVDD。多变量调整后的逻辑回归根据饮食预测因素估计LVDD的风险，并对传统心血管疾病风险因素进行了调整。与最低三分位数相比，总蛋白（OR = 3.30，95%CI：1.46，7.45）和动物蛋白（OR = 2.91，95%CI：1.34，6.34）摄入量处于中间三分位数的参与者发生LVDD的风险最高。蔬菜摄入量处于中间三分位数与最低三分位数的人群发生LVDD的风险分别低77%（OR = 0.23，95%CI：0.11，0.49）和豆类摄入量处于中间三分位数与最低三分位数的人群发生LVDD的风险分别低56%（OR = 0.44，95%CI：0.22，0.85）。总蛋白、动物蛋白、加工肉类和蛋类的摄入量显示出LVDD风险增加的二次趋势，而豆类和蔬菜的摄入量则显示出LVDD风险降低的二次趋势（所有二次趋势P < 0.05）。
动物食物含量高而植物食物含量低的饮食与LVDD风险增加有关。这些发现表明饮食对LVDD有阈值效应，超过该阈值，更多传统的心脏代谢决定因素在HFpEF风险中起更大作用。
