Women who had a food intake similar to the Dietary Approaches to Stop
Hypertension (DASH) diet, with high consumption of fruits, vegetables, and whole
grains and a low intake of fat and dairy products, had a reduced risk of
developing heart failure in a recent study [1].

The DASH diet has been shown to reduce blood pressure, and observational studies
have also suggested that it may reduce the risk of coronary heart disease and
stroke. The current research, published in the May 11, 2009 issue of the
Archives of Internal Medicine, looked at whether such a diet could also reduce
the risk of heart failure in healthy women.

Researchers, led by Dr Emily Levitan (Beth Israel Deaconess Medical Center,
Boston, MA), studied 36 019 women aged 48 to 83 years taking part in the Swedish
Mammography Cohort. The women did not have heart failure, diabetes, or a history
of MI at baseline. Diet was measured using food-frequency questionnaires. A
score was created to assess consistency with the DASH diet, and heart-failure
hospitalization or death was determined using the Swedish inpatient and
cause-of-death registers.

Results showed that women in the top quartile of the DASH component score ate,
on average, three servings of fruit, 3.5 servings of vegetables, 5.1 servings of
whole grains, 1.6 servings of low-fat dairy products, 0.1 servings of sweetened
beverages, and 0.8 servings of red or processed meat per day. In comparison,
women in the bottom quartile of the score ate, on average, 1.4 servings of
fruit, 1.8 servings of vegetables, 3.3 servings of whole grains, 0.6 servings of
low-fat dairy products, 0.4 servings of sweetened beverages, and 1.3 servings of
red or processed meat per day.

During the seven years of follow-up, 443 women developed heart failure. Women in
the top quartile of the DASH diet score had a 37% lower rate of heart failure
after adjustment for age, physical activity, energy intake, education status,
family history of MI, cigarette smoking, postmenopausal hormone use, living
alone, hypertension, high cholesterol concentration, body-mass index, and
incident MI.

Levitan commented to heartwire : "This is the first time it has been shown that
DASH diet is associated with a lower risk of developing heart failure. Previous
studies have suggested a reduced risk of CHD and stroke. I think we can now say
that the blood-pressure benefits known to occur from this diet do seem to
translate into reduced cardiovascular events, including the development of heart
failure."

She noted that, like this study, the heart-disease and stroke studies were also
conducted in women, which is somewhat unusual for cardiac research, which tends
to focus on men. "That was one of the reasons we wanted to focus on women,"
Levitan commented. "And heart failure is a major problem in older women. I would
say the gender difference is less than something like MI. But we have a
follow-up study planned in men," she added.

She pointed out that in the original DASH study, the diet was associated with a
5.5-mm-Hg reduction in blood pressure, which would have accounted for the
reduction in heart failure seen in this study. But reducing lipids and other
mechanisms may also play a role in the benefit seen.

And while only 20% of the women in this study had hypertension, Levitan believes
that a reduction in blood pressure is still beneficial for those normal blood
pressures. "We looked at people with raised blood pressure and those with normal
pressures at baseline, and the DASH diet was protective in both groups. We think
lower blood pressure is better in almost everyone until you get down to very low
pressures. Even if you have a pressure of 125/90, it would probably be better if
it were 115/80," she said. She added that the main goal of the DASH diet is to
increase electrolytes such as calcium, which are thought to antagonize sodium,
which is known to increase blood pressure.

"Our population did not have heart failure at baseline, but I would recommend
patients with heart failure follow this diet. I would also say that this diet is
a particularly healthy one to follow for everyone, but especially for those with
blood-pressure issues," Levitan commented.

Hypertension the Most Common Condition for Which Women Sought Treatment

Approximately 25 million women in the US--most over the age of 45--were treated
for high blood pressure in 2006, making it the most common condition for which
women sought treatment, according to the latest "News and Numbers" from the
Agency for Healthcare Research and Quality (AHRQ) [2]. The statistical analysis
by the AHRQ found that the other most common diseases for which women aged over
45 sought treatment in 2006 included hyperlipidemia, heart disease, and
diabetes.

In terms of expenditure, heart disease tops the table for both men and women.

The data include treatment in doctors' offices and hospital outpatient clinics,
emergency rooms, hospitals, and by home healthcare providers. This analysis was
based on data from AHRQ's Medical Expenditure Panel Survey, which collects
information each year from a nationally representative sample of the US civilian
noninstitutionalized population about their healthcare use, expenses, access to
services, health status, and the quality of the healthcare they obtained.