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Diet/Nutrition in the Prevention and Treatment of Heart Failure Khôi Minh Lê, MD, FACC, FSCAI Co-Director Cardiac Cath Lab Eisenhower Medical Center Rancho Mirage, California Proportion of population living with heart failure H Single centre Ponikowski et al ESC Heart Failure 2014;1:4-25 PREVENTION OF HEART FAILURE ARE THERE RISK FACTORS FOR HEART FAILURE THAT MIGHT BE MODIFIED BY DIET? Obesity and Heart Failure Risk Kenchaiah et al N Engl J Med 2002;347:305-13 Obesity and heart failure risk • Obesity, overweight, and abdominal adiposity increase risk of HF • 2016 Meta-analysis of 28 prospective studies • RR for unit increment in BMI – 1.41 heart failure incidence – 1.26 heart failure mortality Aune et al Circulation 2016 Feb 16;133(7):639-49 Hypertension and Heart Failure Risk SPRINT Research Group The SPRINT Research Group N Engl J Med 2015;373:2103-2116 What’s different in Southeast Asia? Lam ESC Heart Failure 2015;2:46-9 Recommended diets for obesity and hypertension Obesity Paradox in Acute Heart Failure Normal BMI Normal BMI Obese Mortality at 30 Days Shah et al JACC 2014;63:778-75 Obese Mortality at Year The Obesity Paradox is a Global Phenomenon Shah et al JACC 2014;63:778-75 Cardiac Cachexia • Protein-calorie malnutrition with muscle wasting and peripheral edema • Mechanisms – Malabsorption due to intestinal edema, hepatic congestion – Cytokine-mediated anorexia – ↓food intake due to dyspnea, fatigue SODIUM RESTRICTION IN ACUTE AND CHRONIC HEART FAILURE Global Consensus for Sodium Restriction Gupta et al Circulation 2012;126:479-485 Observational studies favoring sodium restriction • 123 patients EF2800 mg/d associated with 3-fold higher rate of HF readmissions Arcand et al Am J Clin Nutr 2011;93:332-337 • 232 patients EF3000 mg/d associated with increase in death/hospitalization Son et al J Clin Nurs 2011;20:3029-38 Effects of Nutritional Intervention • Sodium (2000-2400 mg/d) and fluid (1.5 L/d) restriction vs standard care in 65 patients with HF • Improved NYHA functional class with dietary intervention Colin Ramirez et al Nutrition 2004:(20)890-5 Intervention 70 60 50 40 30 20 10 Standard ↑Na+, ↓Fluids, High Dose Diuretics An Improved Paradigm? • Several studies by same authors at a single center • Moderate-to-high sodium intake combined with fluid restriction and high doses of furosemide reduced mortality, hospitalizations, and laboratory results (BNP, BUN, Cr) • These results have not been confirmed by other investigators Licata et al Am Heart J 2003;145:459-66 Paterna et al JACC 2005;45:1997-2003 Parrinello et al J Card Fail 2009;15:864-73 Dietary sodium restriction Detrimental outcomes in heart failure?