Association between the Dietary Approaches to Stop Hypertension (DASH) diet and risk of incident heart failure and heart failure-related death: a UK Biobank cohort study
Lee P Liao, Patroys De Paz, Simone Marschner, Gary C H Gan, Liza Thomas, Luigi Fontana, Sarah ZamanBackground
Evidence supporting dietary interventions for heart failure (HF) prevention remains limited. The Dietary Approaches to Stop Hypertension (DASH) diet has been proposed as a cardioprotective dietary pattern, but population-level evidence linking DASH adherence to HF risk is sparse.
Aim
To examine the association between adherence to the DASH diet—characterised by high intake of vegetables, fruits and whole grains, and lower consumption of sodium and red and processed meat—with combined risk of HF incidence and death due to HF, as well as its risk factors, namely hypertension and type 2 diabetes mellitus (T2DM).
Methods
A prospective cohort analysis was conducted using UK Biobank participants free of HF at baseline (2006–2010), with follow-up to 2024. Dietary intake was assessed using ≥2 instances of 24-hour recall. DASH scores were derived and categorised into quintiles. Fine-Gray competing risks Cox models estimated adjusted HRs (aHRs) and 95% CIs for a primary composite outcome of incident HF or HF-related death, adjusting for sociodemographic factors, deprivation, obesity, smoking, hypertension and T2DM and accounting for all-cause mortality. Secondary outcomes were incident hypertension and T2DM.
Results
Among 124 777 participants (mean age 56.1±7.8 years; 56% female; 7% with diabetes; 36% with hypertension), followed for a mean of 12 years, 2931 HF events and 441 HF-related deaths occurred. Compared with the lowest DASH adherence quintile, the highest quintile had a lower risk of HF after adjustment for sociodemographic factors (aHR 0.79, 95% CI 0.70 to 0.89, p<0.001) and comorbidities (aHR 0.89, 95% CI 0.79 to 1.00, p<0.05). Greater DASH adherence was associated with reduced risk of hypertension (aHR 0.91, 95% CI 0.86 to 0.96, p<0.001) and T2DM (aHR 0.82, 95% CI 0.75 to 0.90, p<0.001).
Conclusions
Greater adherence to the DASH diet was associated with lower combined risk of HF and death due to HF, as well as hypertension and T2DM, supporting the role of a DASH diet in HF prevention.