Dietary Inflammatory Score and Incident Heart Failure in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Background: Inflammation plays a key role in the development of heart failure (HF), and diet is a known modifiable factor that modulates systemic inflammation. The dietary inflammatory score (DIS) is a tool to quantify the inflammatory components of diet. We sought to determine whether the DIS is associated with incident HF events.

Methods: We examined a total of 17,975 participants without HF at baseline within the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. The main exposure variable was DIS quartile, which was derived from the Food Frequency Questionnaire obtained at baseline study enrollment. The main outcome was incident HF event, defined as HF hospitalization or death. To examine the association between DIS and incident HF events, we conducted Cox proportional hazard regression modeling, adjusting for total energy intake, sociodemographic factors, and pro-inflammatory lifestyle behaviors.

Results: The sample mean age was 64 + 9.2 years, 55.8% were female, and 32.3% were Black. Over a median follow-up of 11.1 years, we observed 900 incident HF events, including 752 hospitalizations and 148 HF deaths. In an adjusted model, the highest DIS quartile (Q4) was associated with incident HF (HR 1.26 95% CI 1.03-1.54). Of note, these findings remained even after adjusting for comorbid conditions and physiologic parameters. In an age-stratified analysis, the association was only present among those aged < 65 years (Q4: HR 1.65 95% CI 1.08-2.51). Moreover, the association was present for HFrEF (Q4: HR 1.44 95% CI 1.07-1.94), but not HFpEF.

Conclusion: The highest DIS quartile was associated with incident HF events. These findings indicate the potential value of specific dietary pattern to prevent HF.