Heart Failure Improvements Seen With Plant-Based Diets

Plant-based diets have been shown to improve both ejection fraction and cardiac remodeling in patients with heart failure among a recent review of interventional studies, thereby lessening the adverse effects of obesity, hyperlipidemia, hypertension, and diabetes, report results published in Cureus.

“The disease is defined by the heart’s inability to pump enough blood to provide the metabolic requirements of the body,” the study’s authors noted. “Current research indicates that antioxidants, micronutrients, and aversion to high fat nutritional choices are associated with reduction in heart failure incidence and morbidity,” the authors noted.

In the United States alone, half of the more than 550,000 people who receive a diagnosis of heart failure each year do not make it to the 5-year mark, and there is a global prevalence of 23 million cases of the disease.

With the risk factors above having a significant association with diet, the authors wanted to assess the both effectiveness of plant-based diet clinical interventions on heart failure, and the role of nutrition, as monotherapy and augmented therapy

Their literature review encompassed clinical studies that occurred from 2000 through March 2020 that focused on patients with heart failure or risk factors for it. PubMed, Medline, and the Cochrane collaboration were used, along with the keywords “vegetarian,” “vegan,” “plant-based diet,” and “heart failure.” Of the 416 studies found, just 3 focused on plant-based diets as interventions, but their results are significant.

The first study concerned improving left ventricular ejection fraction (LVEF), as gauged by improvement in exercise tolerance and risk factors, with a plant-based diet. Its results from comparing those with a max LVEF of 45% and those with an LVEF greater than 40% demonstrated that mean (SD) body mass index (BMI), low-density lipoprotein (LDL) cholesterol, and physical limitations (as measured by the Medical Outcomes Study 36-item Short Form Health Survey [MOS SF-36]) all improved after 3 months of a strict plant-based diet:

• BMI: LVEF <40%: 27.1 (6.4) to 23.3 (6.1) kg/m² LVEF >40%: 24.3 (8.1) to 21.6 (7.6) kg/m²
• LDL cholesterol: LVEF <40%: 126.7 (32.6) to 98.2 (27.6) mg/dL LVEF >40%: 124.8 (52.6) to 106.5 (47.5) mg/dL

• MOS SF-36: LVEF <40%: 44.8±10.3 to 48.0 (9.3) LVEF >40%: 46.2 (9.7) to 49.7 (8.5)

Study 2 focused on improving left ventricular systolic dysfunction and a 35% ejection fraction through a whole-food plant-based diet intervention. At the end of the 60-day period, ejection fraction became normalized to 50% and exercise tolerance increased. Significant improvements were also seen in total cholesterol, triglycerides, and LDL cholesterol:

• Total cholesterol: 201 to 137 mg/dL (32% decrease)
• Triglycerides: 112 to 96 mg/dL (14% decrease)
• LDL cholesterol: 105 to 67 mg/dL (36% decrease)

The third study looked into how an average of 79 days on a plant-based diet could impact outcomes among patients with congestive heart failure. Results from cardiac magnetic resonance imaging demonstrated the following mean (SD) improvements:

• Ejection fraction: 22.0% (6.9%) vs 42.2% (18.4%)
• Stroke volume: 55.8&#8239; (&#8239;24.3) vs 90.3&#8239; (&#8239;30.6) cc
• Cardiac output: 3.6&#8239; (&#8239;1.2) vs 4.2&#8239; (1.6) &#8239;L/min
• Left ventricular mass: 214&#8239; (90) vs 170&#8239; (&#8239;10) g

“A number of small studies in the past 2 decades show a consistent positive clinical and risk factor improvements in patients with heart failure,” the authors concluded. “These findings, although in small samples, can lead the way for more interventional studies with more rigorous design to shed more light on the effects of plant-based diet on heart failure as a clinical intervention.”

Their limitations include the small sample size (50 patients), that their review focused on case studies, and that plant-based diets can vary in their nutrient content, so the exact effects of such an intervention cannot be linked to exact measures of improvement at this time.

Larger interventional studies with a more structured design are needed for statistical significance and to lessen how much influence confounders can have on any study variables being investigated.

Reference

Alasmre FA, Alotaibi HA. Plant-based diet: a potential intervention for heart failure. Cureus. Published online May 25, 2020. doi:10.7759/cureus.8282