Dietary predictors of heart failure with preserved ejection fraction among middle-aged adults in the CARDIA study

Heart failure (HF) is among the leading diagnoses for those admitted to the hospital over 65 years old in high-income countries. While there is strong evidence for the use of pharmacological interventions in the treatment of HF with reduced ejection fraction (HFrEF), there is limited evidence for a similar approach to decreasing morbidity and mortality of HF with preserved ejection fraction (HFpEF). This discrepancy highlights the importance of lifestyle change (i.e. diet) for prevention of HFpEF. Given the paucity of data on dietary predictors of HFpEF and the recent changes in diagnostic criteria, we set out to assess the associations of dietary and demographic predictors with HFpEF in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort. We found that males in their fifties compared to age-matched females had worse measures of diastolic function (e' lateral: 8.47 ± 2.28 vs. 8.98 ± 2.49, p < .001) and myocardial shortening (i.e. GLS: -15.91 ± 2.73 vs -16.98 ± 3.1, p < .001). Each one point of GLS increase was associated with 12 % increase in risk of HFpEF, while HDL intake was found to be protective against HFpEF. We also found that higher dietary HDL intake when individuals were in their fifties was associated with higher (i.e. better) measures of both e' lateral and e' septal velocities. Our data indicate that GLS appears to be a robust predictor of HFpEF and is influenced by dietary behaviors across the lifespan that affect BMI in males and hypertension in females.