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Left ventricular diastolic abnormalities in vegetarians compared with non-vegetarians

Published online by Cambridge University Press:  20 October 2022

Padmini Varadarajan ,
Ramdas G. Pai ,
Gary E. Fraser Open the ORCID record for Gary E. Fraser [Opens in a new window] ,
Dmitry Abramov ,
Brice Jabo ,
Andrew Mashchak ,
Patricia Herring ,
Barbara Burton ,
Lars E. Sveen  and
Synnove F. Knutsen
Padmini Varadarajan
Affiliation:
Loma Linda University, Medical Center, School of Medicine, Loma Linda, CA 92350, USA University of California Riverside, School of Medicine, Riverside, CA, USA
Ramdas G. Pai
Affiliation:
University of California Riverside, School of Medicine, Riverside, CA, USA
Gary E. Fraser*
Affiliation:
Loma Linda University, Medical Center, School of Medicine, Loma Linda, CA 92350, USA Loma Linda University, School of Public Health, Loma Linda, CA, USA
Dmitry Abramov
Affiliation:
Loma Linda University, Medical Center, School of Medicine, Loma Linda, CA 92350, USA
Brice Jabo
Affiliation:
Loma Linda University, School of Public Health, Loma Linda, CA, USA
Andrew Mashchak
Affiliation:
Loma Linda University, School of Public Health, Loma Linda, CA, USA
Patricia Herring
Affiliation:
Loma Linda University, School of Public Health, Loma Linda, CA, USA
Barbara Burton
Affiliation:
Loma Linda University, School of Public Health, Loma Linda, CA, USA
Lars E. Sveen
Affiliation:
Loma Linda University, School of Public Health, Loma Linda, CA, USA
Synnove F. Knutsen
Affiliation:
Loma Linda University, School of Public Health, Loma Linda, CA, USA
*
*Corresponding author: Dr G. E. Fraser, email gfraser@llu.edu
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Abstract

Vegetarians have less hypertension, diabetes mellitus and obesity, hence possibly lower risk of congestive heart failure (HF). We studied associations between vegetarian diets and echocardiographic markers of stage B HF. In a cross-sectional study, dietary pattern was ascertained by a validated FFQ. Echocardiograms were interpreted using standardised criteria. Participants were free-living subjects in Southern California who were older Adventist Health Study-2 cohort members. After exclusions, 133 subjects aged >60 years were enrolled. Their mean age was 72·7 (sd 8·7) years, 48·1 % were female, 32 % were African American and 71 % were vegetarian. Non-vegetarians had higher body weight (80·3 (sd 15·17) kg v. 71·3 (sd 16·2), P < 0·005), body surface area (1·92 (sd 0·24) m2 v. 1·81 (sd 0·22) m2, P = 0·01) and prevalence of hypertension (63 % v. 47 %, P = 0·10). Adjusting for age, sex, race and physical activity, it is found that vegetarians had greater echocardiographic mitral annular e’ velocity (a measure of left ventricular (LV) relaxation) 7·44 v. 6·48 (non-vegetarian) cm/s (P = 0·011) and a yet greater contrast when vegans (7·66 cm/s, P = 0·011) were the group of interest. The ratio mid-to-late-diastolic mitral flow velocity (E/A) was also higher in vegans compared with non-vegetarians (1·02 and 0·84, respectively, P = 0·008). Mediation analyses suggested these associations may be partly related to higher blood pressures and BMI in the non-vegetarians. We conclude that vegetarians, especially vegans, appear to have better LV relaxation and fewer diastolic abnormalities than others. As dietary exposure is modifiable, one may speculate pending further investigation about the potential for reduction of stage B HF and later mortality.

Keywords

DietVegetarianismHeart failureStage B heart failureLeft ventricular massDiastolic function
Type
Research Article
Information
British Journal of Nutrition , Volume 130 , Issue 3 , 14 August 2023 , pp. 467 - 475
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Nutrition Society

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References

Tonstad, S, Stewart, K, Oda, K, et al. (2013) Vegetarian diets and incidence of diabetes in the Adventist Health study-2. Nutr Metab Cardiovasc Dis 23, 292–299.CrossRefGoogle ScholarPubMed
Fraser, GE, Katuli, S, Anousheh, R, et al. (2014) Vegetarian diets and cardiovascular risk factors in black members of the Adventist Health study-2. Public Health Nutr 17, 1–9.Google Scholar
Pettersen, BJ, Anousheh, R, Fan, J, et al. (2012) Vegetarian diets and blood pressure among white subjects: results from the Adventist Health study-2. Public Health Nutr 15, 1909–1916.CrossRefGoogle ScholarPubMed
Matsumoto, S, Beeson, WL, Shavlik, D, et al. (2019) Association between vegetarian diets and cardiovascular risk factors in non-Hispanic white participants of the Adventist Health study-2. J Nutr Sci 8, 1–12.CrossRefGoogle ScholarPubMed
Fraser, GE (2015) A comparison of first event CHD rates in two contrasting California populations. J Nutr Health Aging 9, 53–58.Google Scholar
Ha, J-W, Choi, D, Park, S, et al. (2009) Left ventricular diastolic functional reserve during exercise in patients with impaired myocardial relaxation at rest. Heart 95, 399–404.CrossRefGoogle ScholarPubMed
Grewal, J, McCully, RB, Kane, G, et al. (2009) Left ventricular function and exercise capacity. JAMA 301, 286–294.CrossRefGoogle ScholarPubMed
AlJaroudi, WA, Alraies, MV, Halley, C, et al. (2013) Incremental prognostic value of diastolic dysfunction in low risk patients undergoing echocardiography: beyond Framingham score. Int J Cardiovasc Imaging 29, 1441–1450.CrossRefGoogle ScholarPubMed
Jaceldo-Siegl, K, Fan, J, Sabate, J, et al. (2011) Race-specific validation of food intake obtained from a comprehensive FFQ: the Adventist Health study-2. Public Health Nutr 14, 1988–1997.CrossRefGoogle ScholarPubMed
Lang, RM, Bierig, M, Devereux, RB, et al. (2005) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 18, 1440–1463.CrossRefGoogle Scholar
Nagueh, SF, Appleton, CP, Gillebert, TC, et al. (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 22, 107–133.CrossRefGoogle Scholar
Rudski, LG, Lai, WW, Afilalo, J, et al. (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American society of echocardiography endorsed by the European association of echocardiography, a registered branch of the European society of cardiology, and the Canadian society of echocardiography. J Am Soc Echocardiogr 23, 685–713.CrossRefGoogle Scholar
McKee, PA, Castelli, WP, McNamara, PM, et al. (1971) The natural history of congestive heart failure: the Framingham study. N Engl J Med 285, 1441–1446.CrossRefGoogle ScholarPubMed
Hastie, T, Tibshirani, R & Friedman, J (2009) The Elements of Statistical Learning. Data Mining, Inference and Prediction. 2nd ed. New York, NY: Springer.Google Scholar
Vanderweele, T (2016) Mediation analysis: a practitioner’s guide. Ann Rev Pub Health 37, 17–32.CrossRefGoogle ScholarPubMed
Efron, B & Tibshirani, RJ (1993) An Introduction to the Bootstrap. New York: Chapman and Hall.CrossRefGoogle Scholar
Halley, C, Houghtaling, PL, Khalil, MK, et al. (2011) Mortality rate in patients with diastolic dysfunction and normal systolic function. Arch Int Med 171, 1082–1087.CrossRefGoogle ScholarPubMed
Gulati, V, Katz, WE, Follansbee, WP, et al. (1996) Mitral annular descent velocity by tissue Doppler echocardiography as index of global left ventricular function. Am J Cardiol 77, 979–984.CrossRefGoogle ScholarPubMed
Sohn, DW, Chai, IH, Lee, DJ, et al. (1997) Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 30, 474–480.CrossRefGoogle ScholarPubMed
Oki, T, Tabata, T, Yamada, H, et al. (1997) Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation. Am J Cardiol 79, 921–928.CrossRefGoogle ScholarPubMed
Nagueh, SF, Middleton, KJ, Kopelen, HA, et al. (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30, 1527–1533.CrossRefGoogle ScholarPubMed
Nagueh, SF, Mikati, I, Koplen, HA, et al. (1998) Doppler estimation of left ventricular filling pressure in sinus tachycardia: a new application of tissue Doppler imaging. Circulation 98, 1644–1650.CrossRefGoogle ScholarPubMed
Simpson, IA (1997) Echocardiographic assessment of the long axis: a simple solution to a complex problem. Heart 78, 211–212.CrossRefGoogle Scholar
Ohte, N, Narita, H, Hashimoto, T, et al. (1999) Differentiation of abnormal relaxation pattern with aging from abnormal relaxation pattern with coronary artery disease in transmitral flow with the use of tissue Doppler imaging of the mitral annulus. J Am Soc Echocardiogr 12, 629–635.CrossRefGoogle ScholarPubMed
Oki, T, Tabata, T, Yamada, H, et al. (1998) Left ventricular diastolic properties of hypertensive patients measured by pulsed tissue Doppler imaging. J Am Soc Echocardiogr 11, 1106–1112.CrossRefGoogle ScholarPubMed
Nagueh, SF, Sun, HB, Kopelen, HA, et al. (2001) Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. J Am Coll Cardiol 37, 278–285.CrossRefGoogle ScholarPubMed
Yip, GW, Zhang, Y, Tan, PY, et al. (2002) Left ventricular long-axis changes in early diastole and systole: impact of systolic function on diastole. Clin Sci 102, 515–522.CrossRefGoogle ScholarPubMed
Abuzaid, A, Cohen, BE, Pursnani, S, et al. (2019) Who is young at heart and when? Diastolic Doppler data from the mind your heart study. Echocardiography 36, 1744–1746.CrossRefGoogle Scholar
Fraser, GE & Shavlik, DJ (2001) Ten years of life. Is it a matter of choice? Arch Int Med 161, 1645–1652.CrossRefGoogle ScholarPubMed
Fraser, GE, Cosgrove, CM, Mashchak, AD, et al. (2020) Lower rates of cancer and all-cause mortality in an Adventist cohort compared with a US Census population. Cancer 126, 1102–1111.CrossRefGoogle Scholar
Garcia, MJ, Ares, MA, Asher, C, et al. (1997) An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure. J Am Coll Cardiol 29, 448–454.CrossRefGoogle Scholar
Moller, JE, Sondergaard, E, Poulsen, SH, et al. (2001) Color M-mode and pulsed wave tissue Doppler echocardiography: powerful predictors of cardiac events after first myocardial infarction. J Am Soc Echocardiogr 14, 757–763.CrossRefGoogle ScholarPubMed
de Simone, G, Devereux, RB, Camargo, MJ, et al. (1993) Influence of sodium intake on in vivo left ventricular anatomy in experimental renovascular hypertension. Am J Physiol 264, H2103–H2110.Google ScholarPubMed
Ashaye, A, Gaziano, J & Djousse, L (2011) Red meat consumption and risk of heart failure in male physicians. Nutr Metab Cardiovasc Dis 21, 941–946.CrossRefGoogle ScholarPubMed
Ueland, T, Svardal, A, Oie, E, et al. (2013) Disturbed carnitine regulation in chronic heart failure – increased plasma levels of palmitoyl-carnitine are associated with poor prognosis. Int J Cardiol 167, 1892–1899.CrossRefGoogle ScholarPubMed
Levitan, EB, Lewis, CE, Tinker, LF, et al. (2013) Mediterranean and DASH diet scores and mortality in women with heart failure: the Women’s health initiative. Circ Heart Fail 6, 1116–1123.CrossRefGoogle ScholarPubMed
Diaz, R, Lorita, J, Soley, M, et al. (2008) Carnitine worsens both injury and recovery of contractile function after transient ischemia in perfused rat heart. J Physiol Biochem 64, 1–8.CrossRefGoogle ScholarPubMed
St-Onge, M-P, Ard, J, Baskin, ML, et al. (2017) Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation 135, e96–e121.CrossRefGoogle ScholarPubMed
Swiatkiewicz, I, Woźniak, A & Taub, PR (2021) Time-restricted eating and metabolic syndrome: current status and future perspectives. Nutrients 13, 221.CrossRefGoogle ScholarPubMed
Swiatkiewicz, I, Di Somma, S, De Fazio, L, et al. (2021) Effectiveness of intensive cardiac rehabilitation in high-risk patients with cardiovascular disease in real-world practice. Nutrients 13, 3883.CrossRefGoogle ScholarPubMed
Ussher, JR, Lopaschuk, GD & Arduini, A (2013) Gut microbiota metabolism of L-carnitine and cardiovascular risk. Atherosclerosis 231, 456–461.CrossRefGoogle ScholarPubMed
Flanagan, JL, Simmons, PA, Vehige, J, et al. (2010) Role of carnitine in disease. Nutr Metab 7, 30.CrossRefGoogle ScholarPubMed
Fraser, GE, Sabaté, J, Beeson, WL, et al. (1992) A possible protective effect of nuts and whole wheat bread on risk of coronary heart disease: the Adventist Health study. Arch Intern Med 152, 1416–1424.CrossRefGoogle ScholarPubMed
Tharrey, M, Mariotti, F, Mashchak, A, et al. (2018) Patterns of plant and animal protein intake are strongly associated with cardiovascular mortality: the Adventist Health study-2 cohort. Int J Epidemiol 47, 1603–1612.CrossRefGoogle ScholarPubMed
Hara, M, Sakata, Y, Nakatani, D, et al. (2013) Low levels of serum n-3 polyunsaturated fatty acids are associated with worse heart failure-free survival in patients after acute myocardial infarction. Circ J 77, 153–162.CrossRefGoogle ScholarPubMed
Wilk, JB, Tsai, MY, Hanson, NQ, et al. (2012) Plasma and dietary n-3 fatty acids, fish intake, and heart failure risk in the Physicians’ Health study. Am J Clin Nutr 96, 882–888.CrossRefGoogle ScholarPubMed
Qin, W, Du, N, Zhang, L, et al. (2015) Genistein alleviates pressure overload-induced cardiac dysfunction and interstitial fibrosis in mice. Br J Pharmacol 172, 5559–5572.CrossRefGoogle ScholarPubMed
Hagen, MK, Ludke, A, Araujo, AS, et al. (2012) Antioxidant characterization of soy derived products in vitro and the effect of a soy diet on peripheral markers of oxidative stress in a heart disease model. Can J Physiol Pharmacol 90, 1095–1103.CrossRefGoogle Scholar
Matori, H, Umar, S, Nadadur, RD, et al. (2012) Genistein, a soy phytoestrogen, reverses severe pulmonary hypertension and prevents right heart failure in rats. Hypertension 60, 425–430.CrossRefGoogle ScholarPubMed
Kannel, WB (1975) Role of blood pressure in cardiovascular disease: the Framingham Heart study. Angiology 26, 1.CrossRefGoogle Scholar
Longjian, L, Lima, JAC, Post, WS, et al. (2021) Associations of time-varying obesity and metabolic syndrome with risk of incident heart failure and its subtypes: findings from the multi-ethnic study of atherosclerosis. Int J Cardiol 338, 127–135.Google Scholar
Obokata, M, Reddy, YNV, Pislaru, SV, et al. (2017) Evidence supporting the existence of a distinct obese phenotype of heart failure with preserved ejection fraction. Circulation 136, 6–19.CrossRefGoogle ScholarPubMed
Vaidya, GN & Abramov, D (2018) Echocardiographic evaluation of diastolic function is of limited value in the diagnosis and management of HFpEF. J Card Fail 24, 392–396.CrossRefGoogle ScholarPubMed
Oh, JK, Miranda, WR, Bird, JG, et al. (2020) The 2016 diastolic function guideline: is it already time to revisit or revise them? JACC Cardiovasc Imaging 13, 327–335.CrossRefGoogle ScholarPubMed
Bozkurt, B, Coats, A, Tsutsu, H, et al. (2021) Universal definition and classification of heart failure. A report of the heart failure society of America, heart failure association of the European society of cardiology, Japanese heart failure society and writing committee of the universal definition of heart failure. J Card Fail 27, 387–413.CrossRefGoogle Scholar
Miles, FL, Mashchak, A, Filippov, V, et al. (2020) DNA methylation profiles of vegans and non-vegetarians in the Adventist Health Study-2 cohort. Nutrients 12, 3697.CrossRefGoogle ScholarPubMed
Miles, FL, Orlich, MJ, Mashchak, A, et al. (2022) The biology of veganism: plasma metabolomics analysis reveals distinct profiles of vegans and non-vegetarians in the Adventist Health Study-2 cohort. Nutrients 14, 709.CrossRefGoogle ScholarPubMed