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Periodic Fasting and Acute Cardiac Events in Patients Evaluated for COVID-19: An Observational Prospective Cohort
Benjamin D Horne1,2,3, Jeffrey L Anderson1,4, Francois Haddad2,3
1Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA.
Insights
Periodic fasting was linked to reduced heart failure hospitalizations and major adverse cardiovascular events in COVID-19 patients. This dietary approach may offer cardiovascular benefits during and after viral infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Nutritional Science
Background:
- Periodic fasting has been linked to longevity and reduced heart failure (HF) risk.
- Previous studies suggest periodic fasting may lower mortality and hospitalization in COVID-19 patients.
Purpose of the Study:
- To evaluate the association between periodic fasting and HF hospitalization.
- To assess the impact of periodic fasting on major adverse cardiovascular events (MACEs).
Main Methods:
- A cohort of 5227 patients from the INSPIRE registry (Feb 2013-Mar 2020) was analyzed.
- The study focused on 601 COVID-19 positive patients and 1772 COVID-negative patients, with follow-up through March 2023.
- Cox regression models were used to assess HF admissions and MACEs, adjusting for covariates like vaccination status.
Main Results:
- In COVID-19 positive patients, periodic fasting was associated with a 37% lower risk of HF hospitalization (aHR=0.63) and a 36% lower risk of MACEs (aHR=0.64).
- Among COVID-19 positive patients, 13.3% of fasters experienced HF hospitalization compared to 22.1% of non-fasters.
- Periodic fasting was associated with significantly lower mortality in both COVID-19 positive and negative patients combined (aHR=0.60).
Conclusions:
- Routine periodic fasting is associated with reduced heart failure hospitalizations in patients who test positive for COVID-19.
- Periodic fasting may offer cardiovascular protective benefits for individuals with COVID-19.
Background:
Periodic fasting was previously associated with greater longevity and a lower incidence of heart failure (HF) in a pre-pandemic population. In patients with coronavirus disease 2019 (COVID-19), periodic fasting was associated with a lower risk of death or hospitalization. This study evaluated the association between periodic fasting and HF hospitalization and major adverse cardiovascular events (MACEs).
Methods:
Patients enrolled in the INSPIRE registry from February 2013 to March 2020 provided periodic fasting information and were followed into the pandemic (n = 5227). Between March 2020 and February 2023, N = 2373 patients were studied, with n = 601 COVID-positive patients being the primary study population (2836 had no COVID-19 test; 18 were excluded due to fasting <5 years). A Cox regression was used to evaluate HF admissions, MACEs, and other endpoints through March 2023, adjusting for covariables, including time-varying COVID-19 vaccination.
Results:
In patients positive for COVID-19, periodic fasting was reported by 180 (30.0% of 601), who periodically fasted over 43.1 ± 19.2 years (min: 7, max: 83). HF hospitalization (n = 117, 19.5%) occurred in 13.3% of fasters and 22.1% of non-fasters [adjusted hazard ratio (aHR) = 0.63, CI = 0.40, 0.99; p = 0.044]. Most HF admissions were exacerbations, with a prior HF diagnosis in 111 (94.9%) patients hospitalized for HF. Fasting was also associated with a lower MACE risk (aHR = 0.64, CI = 0.43, 0.96; p = 0.030). In n = 1772 COVID-negative patients (29.7% fasters), fasting was not associated with HF hospitalization (aHR = 0.82, CI = 0.64, 1.05; p = 0.12). In COVID-positive and negative patients combined, periodic fasting was associated with lower mortality (aHR = 0.60, CI = 0.39, 0.93; p = 0.021).
Conclusions:
Routine periodic fasting was associated with less HF hospitalization in patients positive for COVID-19.
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