Diet Prevention and Therapy for Heart Failure?
In the current issue of Circulation: Heart Failure, 2 provocative articles address the influence of diet as therapy for heart failure (HF). Although the studies vary greatly in design and in neither case are the findings definitive, they are indeed intriguing. They require us to pause in the march toward optimal evidence-based medical and device therapy and reconsider not only the preventive but also the therapeutic benefits of diet in the management of patients with known HF.
Articles see p 1116 and 1165
Multiple iterations of the American College of Cardiology Foundation/American Heart Association HF clinical practice guidelines have endorsed, with a high degree of reasonable evidence, the importance of sodium restriction, particularly in American College of Cardiology Foundation/American Heart Association stage A and stage B HF.1 There is reasonable certainty that diet modification is an effective strategy to prevent HF and modify the progression from stage A to stage B. More trepidation emerges in consideration about the strength of recommendations for sodium restriction for stage C and stage D HF: Class IIa, level of evidence C, Sodium restriction is reasonable for patients with symptomatic HF to reduce congestive symptoms. This hardly definitive recommendation was driven by a surprising lack of evidence addressing sodium restriction specifically and dietary management more broadly.2 The 2012 European Society of Cardiology Heart Failure Guideline3 opted to provide no recommendations on sodium restriction in symptomatic HF precisely because of the poor evidence base. Recent data, albeit of questioned validity, have even suggested the possibility of harm in those patients with symptomatic HF who undergo significant sodium restriction.4,5
Regarding other dietary recommendations, the current American College of Cardiology Foundation/American Heart Association HF guidelines endorse the use of omega-3 fatty acids for therapeutic benefit in HF with reduced ejection fraction …