Congestive Heart Failure Archives - Health Tips From The Professor

What Diet Is Best For Healthy Aging?

October 28, 2025 by Dr. Steve Chaney

What About Primarily Meat-Based Diets?

Author: Dr. Stephen Chaney

It’s so confusing. Everyone claims they have clinical proof that their diet is the best. You will be healthier and live longer.

But the diets are so different. They range from vegan to keto. They can’t all be equally healthy. What is the truth?

To answer that question, we first need to understand how the proponents of each diet can claim theirs is the perfect diet for health and longevity. It’s because they base their claims on:

Short-term studies. Most of their claims are based on studies that range from a few weeks to a few months. You need 20- or 30-year studies to measure the effects of a particular diet on health outcomes.

Biological markers (Things like cholesterol and triglyceride levels, blood sugar control, and/or inflammation). Biological markers can predict possible health outcomes. But without long-term studies on actual health outcomes, you don’t know whether those predictions are accurate.

Comparisons with the typical American diet. Any diet looks good compared with the American diet.

Elimination of highly processed foods. While these diets emphasize different foods, they are all whole food diets. Again, any diet that eliminates processed foods is an improvement.

- It doesn’t matter whether you restrict calories, restrict certain foods or food groups, or restrict the time you allow yourself to eat. You unconsciously eat less.

- And when you eat less, you lose weight.

- And when you lose weight, your cholesterol and triglyceride levels fall, your blood sugar control improves, and inflammation decreases.

- That’s why short-term weight loss and improvement in biological markers are virtually identical with vegan and keto diets. Those diets are as different as any two diets could be. But they are both highly restrictive diets.

The take-home lesson is clear. Don’t be confused by claims based on short-term studies. What you should look for is:

Long-term studies (20 years or more)…

that look at the effect of diet on health outcomes, and…

do not compare their diet with the typical American diet.

When I first reviewed this topic 8 years ago, I could only find a few studies that met these criteria:

One study showed that people consuming primarily plant-based diets weighed less than people who consumed primarily meat-based diets for 20 years or more.

Other studies showed that people consuming primarily plant-based diets had a reduced risk of diabetes and heart disease compared to people consuming primarily meat-based diets for 20 years or more.

These are valuable observations, but they are limited. That’s why I was so excited when I came across a recent 30-year study (A-J Tessier et al, Nature Medicine, volume 31, pages 1644-1652, 2025) looking at the effect of 9 different diets on longevity and health outcomes. In short, this study looked at the effect of different diets on healthy aging.

How Was This Study Done?

The authors of this study used data from 105,015 participants in the Nurses’ Health Study (NHS) and Health Professionals Follow Up Study (HPFS). Both studies enrolled participants in 1986 and followed them through 2016. In short, they were both 30-year studies. Participants with preexisting chronic diseases were excluded from the study.

Lifestyle factors and medical histories were assessed every two years.

A detailed dietary assessment was conducted every four years. The assessments measured the intake of 152 foods. Food intakes were averaged over the duration of the study for each participant.

[Note: This study did not measure how the diets of participants changed between 1986 and 2016, although that is an interesting question. Perhaps a future study is planned.]

Based on the foods eaten, the diets of the participants were evaluated for adherence to 9 dietary patterns, which I have described in more detail below.

[Note: To be clear, the participants were not trying to follow these diets. They ate what they ate, and the investigators subsequently compared their dietary pattern with various healthy diets.]

For each of the diets included in this study, participants were divided into quintiles based on how closely their food intake adhered to the recommendations for that diet. Then the highest quintile was compared to the lowest quintile to determine how well that diet predicted “healthy aging” after a 30-year follow-up.

The term “healthy aging” was based on 5 criteria:

Longevity – achieving an age of 70 or more.

Absence of the top 11 major chronic diseases (cancer, diabetes, myocardial infarction (heart attack), coronary artery disease, congestive heart failure, stroke, Parkinson’s disease, multiple sclerosis, and ALS).

No impairment of cognitive function.

No impairment of physical health.

No mental health issues.

In other words, these were not just individuals who survived 70 years or more. They survived and thrived. They were enjoying their golden years because they still had good health and excellent quality of life.

Diets Included In This Study

The diets included in this study were:

AHEI – Alternative Healthy Eating Index (A scoring system developed by Harvard researchers to measure overall diet quality based on its ability to predict lower risks of heart attacks, strokes, and diabetes).

aMed – Alternative Mediterranean Diet Index (The aMed diet index differs from the original Med index by separating fruits and nuts into different groups, eliminating dairy, emphasizing whole grains, and excluding red and processed meats in favor of chicken and fish).

DASH – Dietary Approaches to Stop Hypertension (The name speaks for itself. But I also sometimes refer to this diet as “the Americanized version of the Mediterranean diet’ because it features foods more familiar to Americans. For example, it allows more red meat options than most of the other diets in this list.

MIND – Mediterranean-Dash intervention for Neurogenerative Delay (It is a dietary pattern designed to reduce the risk of Alzheimer’s disease and other forms of dementia. It combines elements of the Mediterranean and DASH diets but differs from both by emphasizing berries as a major fruit source, among other things.)

hPDI – Healthy Plant-Based Diet Index (It is a scoring system that measures adherence to a diet rich in healthy plant-based foods and lower consumption of less-healthy plant foods and animal foods.)

PHDI – Planetary Health Diet Index (It emphasizes foods (primarily plant foods) that are healthy and are good for the environment. Of the diets on this list, it is the most restrictive and closest to a vegan diet)

EDIH – Empirical Dietary Index For Hyperinsulinemia (It is a scoring system that measures the potential of a diet to cause chronically high insulin levels, which is associated with type 2 diabetes and certain cancers.)

EDIP – Empirical Dietary Inflammation Pattern (It is a scoring system that measures the inflammatory potential of a diet.)

UPF – Consumption of Ultraprocessed Foods (Since recent studies have shown that most Americans get between 55 and 70% of their calories from ultraprocessed foods, this is fast becoming a measure of the typical American diet.)

Note: Except for the UPF diet, these are all whole food, primarily plant-based diets.

What Diet Is Best For Healthy Aging?

Here are the results of the study (drum roll, please):

Of the 105,015 participants in this study, only 9.3% achieved healthy aging.

Adherence to any of the 8 healthy diets improved the probability of achieving healthy aging.

The odds of achieving healthy aging ranged from 1.45 for the Healthy Plant-Based Diet to 1.86 for the Alternative Healthy Eating Index.

If you were to pick one winner, it would be the Alternative Healthy Eating Index. And if you were to define healthy aging as achieving an age of 75 or more with the other 4 criteria, the odds increase to 2.24 (more than double) for the Alternative Healthy Eating Index.

As you might expect, adherence to a diet high in ultraprocessed foods had the opposite effect. It decreased the odds of achieving healthy aging by 32%.

When you look at each of the criteria for healthy aging individually, the results were a bit more nuanced:

For survival to 70+ years, the Alternative Healthy Eating Index and the Planetary Health Diet Index were tied. Both increased the odds of survival by more than 2-fold.

The Alternative Healthy Eating Index and the Planetary Health Diet Index were also tied for surviving to 70 with intake cognitive health and intact physical function.

The Empirical Dietary Index For Hyperinsulinemia edged out the Alternative Healthy Eating Index for freedom from 11 chronic diseases.

The effect of healthy diets on the odds of achieving healthy aging is independent from BMI, smoking, and physical activity. This means that:

The effects of healthy diets on healthy aging were not because people consuming healthy diets weighed less, smoked less, or exercised more.

Even if some of your lifestyle choices are suboptimal, choosing a healthy diet will increase your odds of surviving and thriving.

Finally, the study looked at the effects of individual foods on healthy aging. The results were:

Higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes, and low-fat dairy products increase your odds of healthy aging.

Higher intakes of trans fats, sodium, sugary beverages, and red or processed meats decrease your odds of achieving healthy aging.

The effects of these foods on healthy aging aren’t novel. They are consistent with dozens of other studies that have looked at the effect of individual foods on long-term health outcomes. In fact, the diets included in this study were chosen because they included foods that positively affect health outcomes and minimize foods that negatively affect health outcomes.

What About Primarily Meat-Based Diets?

I have good friends who advocate for primarily meat-based diets such as keto, paleo, and carnivore. I’m sure they are going to say, “This study is a sham. It only included primarily plant-based diets, so, of course, it is only going to show benefits for primarily plant-based diets.” I can hear their their questions now:

Why didn’t this study include any of the primarily meat-based diets? My answer is: “All the popular meat-based diets exclude one or more of the food groups associated with health and longevity and emphasize one or more of the food groups associated with a shorter, less healthy life. And these food associations are consistent among multiple long-term studies looking at the effect of various foods on health outcomes.

The authors could have constructed a similar index for each of the popular meat-based diets. But they would have been the inverse of the plant-based diet indices because the foods included and excluded from plant-based and meat-based diets are opposite. Therefore, just like the UPF index, they would have been associated with a decreased probability of achieving healthy aging.”

Why did the scientists designing this study ignore the proven health benefits of primarily meat-based diets? My answer is: “The “proven benefits” of primarily meat-based diets are based on short-term studies showing the effects of those diets on biological markers. Long-term studies looking at health outcomes are lacking.”

But modern primarily meat-based diets are a special case because they limit carbohydrates and cause ketosis. Why weren’t they included in the study? My answer is: “The Atkins diet limits carbohydrates and causes ketosis. It has been around for more than 50 years. And, to my knowledge, there are no studies showing it is beneficial long term. If the Atkins diet cannot be shown to have long-term health benefits, it is unlikely that modern diets that mimic it are healthy long term.

What Does This Study Mean For You?

The answer is clear. If you want to survive and thrive in your 70s and beyond, choose a whole food, primarily plant-based diet.

If you want the absolute best diet, follow the Alternative Healthy Eating Index recommendations. There are many online resources to guide you.

However, any whole food, primarily plant-based diet will do. The ones with the most online resources are the Mediterranean, DASH, and MIND diets. Choose the one that best fits your food preferences and lifestyle.

If you want to go more vegetarian, the Healthy Plant-Based Diet is a bit easier than a strict vegan diet.

If you are concerned about the environment, the Planetary Diet is best for you.

If you have specific health issues like hypertension, diabetes, or inflammation, there are diets designed just for you.

And if following structured diets is not your style, just:

Eat more fruits, vegetables, whole grains, unsaturated fats, nuts, legumes, and low-fat dairy products.

Eat less trans fats, sodium, sugary beverages, and red or processed meats, and ultraprocessed foods.

Finally, even if some of your lifestyle choices are suboptimal, this study shows choosing a healthy diet will increase your odds of surviving to your 70s and thriving.

The Bottom Line

A recent 30-year study looked at the effect of 8 whole food, primarily plant-based diets on healthy aging defined as:

Achieving an age of 70 or more.

The absence of the top 11 major chronic diseases.

No impairment of cognitive function.

No impairment of physical health.

No mental health issues.

The key findings were:

Adherence to any of 8 whole food, primarily plant-based diets improved the probability of achieving healthy aging.

The odds of achieving healthy aging ranged from 1.45 for the Healthy Plant-Based Diet to 1.86 for the Alternative Healthy Eating Index.

For more information on this study, why primarily meat-based diets were not considered healthy enough to be included in this study, and what this study means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

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About The Author

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years. Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading Biochemistry textbooks for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 53 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Which Supplements Are Good For Your Heart?

February 7, 2023 by Dr. Steve Chaney

How Should You Interpret This Study?

Author: Dr. Stephen Chaney

February is Heart Health month. So, it is fitting that we ask, “What is the status of heart health in this country?” The American Heart Association just published an update of heart health statistics through 2019 (CW Tsao et al, Circulation, 145: e153-e639, 2022). And the statistics aren’t encouraging. [Note: The American Heart Association only reported statistics through 2019 because the COVID-19 pandemic significantly skewed the statistics in 2020 and 2021].

The Good News is that between 2009 and 2019:

All heart disease deaths have decreased by 25%.
Heart attack deaths have decreased by 6.6%.
Stroke deaths have decreased by 6%.

The Bad News is that:

Heart disease is still the leading cause of death in this country.
Someone dies from a heart attack every 40 seconds.
Someone dies from a stroke every 3 minutes.

Diet, exercise, and weight control play a major role in reducing the risk of heart disease. Best of all, they have no side effects. They represent a risk-free approach that each of us can control.

But is there something else? Could supplements play a role? Are supplements hype or hope for a healthy heart?

All the Dr. Strangeloves in the nutrition space have their favorite heart health supplements. They claim their supplements will single-handedly abolish heart disease (and help you leap tall buildings in a single bound).

On the other hand, many doctors will tell you these supplements are a waste of money. They don’t work. They just drain your wallet.

It’s so confusing. Who should you believe? Fortunately, a recent study (P An et al, Journal of the American College of Cardiology, 80: 2269-2285, 2022) has separated the hype from the hope and tells us which “heart-healthy” supplements work, and which don’t.

How Was This Study Done?

This was a major clinical study carried out by researchers from the China Agricultural University and Brown University in the US. It was a meta-analysis, which means it combined the data from many published clinical trials.

The investigators searched three major databases of clinical trials to identify:

884 randomized, placebo-controlled clinical studies…

Of 27 types of micronutrients…

With a total of 883,627 patients…

Looking at the effectiveness of micronutrient supplementation lasting an average of 3 years on either…

- Cardiovascular risk factors like blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides…or…

- Cardiovascular outcomes such as coronary heart disease (CHD), heart attacks, strokes, and deaths due to cardiovascular disease (CVD) and all causes.

[Note: Coronary heart disease (CHD) refers to build up of plaque in the coronary arteries (the arteries leading to the heart). It is often referred to as heart disease and can lead to heart attacks (myocardial infarction). Cardiovascular disease (CVD) is a more inclusive term that includes coronary heart disease, stroke, congenital heart defects, and peripheral artery disease.]

The investigators also included an analysis of the quality of the data in each of the clinical studies and rated the evidence of each of their findings as high quality, moderate quality, or low quality.

Which Supplements Are Good For Your Heart?

The top 3 heart-healthy supplements in this study were:

Omega-3 Fatty Acids:

Increased HDL cholesterol and decreased triglycerides, both favorable risk factors for heart health.
Deceased risk of heart attacks by 15%, all CHD events by 14%, and CVD deaths by 7% (see definitions of CHD and CVD above).
The median dose of omega-3 fatty acids in these studies was 1.8 g/day.
The evidence was moderate quality for all these findings.

Folic Acid:

Decreased LDL cholesterol (moderate quality evidence) and decreased blood pressure and total cholesterol (low quality evidence).
Decreased stroke risk by 16% (moderate quality evidence).

Coenzyme Q10:

Decreased triglycerides (high quality evidence) and reduced blood pressure (low quality evidence).
Decreased the risk of all-cause mortality by 32% (moderate quality evidence).
These studies were performed with patients diagnosed with heart failure. Coenzyme Q10 is often recommended for these patients, so the studies were likely performed to test the efficacy of this treatment.

There were three micronutrients (vitamin C, vitamin E, and vitamin D) that did not appear to affect heart disease outcomes.

Finally, as reported in previous studies, β-carotene increased the risk of stroke, CVD mortality, and all-cause mortality.

In terms of the question I asked at the beginning of this article, this study concluded that:

Omega-3, folic acid, and coenzyme Q10 supplements represent hope for a healthy heart.
Vitamin C, vitamin E, and vitamin D supplements represent hype for a healthy heart.
β-carotene supplements represent danger for a healthy heart.

But these conclusions just scratch the surface. To put them into perspective we need to dig a bit deeper.

How Should You Interpret This Study?

In evaluating the significance of these findings there are two things to keep in mind.

#1: This study is a meta-analysis and meta-analyses have both strengths and weaknesses.

The strength of meta-analyses is that by combining multiple clinical studies they can end up with a database containing 100s of thousands of subjects. This allows them to do two things:

It allows the meta-analysis to detect statistically significant effects that might be too small to detect in an individual study.
It allows the meta-analysis to detect the average effect of all the clinical studies it includes.

The weakness of meta-analyses is that the design of individual studies included in the analysis varies greatly. The individual studies vary in things like dose, duration, type of subjects included in the study, and much more.

This is why this study rated most of their conclusions as backed by moderate- or low-quality evidence. [Note: The fact that the authors evaluated the quality of evidence is a strength of this study. Most meta-analyses just report their conclusions without telling you how strong the evidence behind those conclusions is.]

#2: Most clinical studies of supplements (including those included in this meta-analysis) have two significant weaknesses.

Most studies do not measure the nutritional status of their subjects prior to adding the supplement. If their nutritional status for a particular nutrient was already optimal, there is no reason to expect more of that nutrient to provide any benefit.
Most studies measure the effect of a supplement on a cross-section of the population without asking who would be most likely to benefit.

You would almost never design a clinical study that way if you were evaluating the effectiveness of a potential drug. So, why would you design clinical studies of supplements that way?

With these considerations in mind, let me provide some perspective on the conclusions of this study.

Coenzyme Q10:

This meta-analysis found that coenzyme Q10 significantly reduced all-cause mortality in patients with heart failure. This is consistent with multiple clinical studies and a recent Cochrane Collaboration review.

Does coenzyme Q10 have any heart health benefits for people without congestive heart failure? There is no direct evidence that it does, but let me offer an analogy with statin drugs.

Statin drugs are very effective at reducing heart attacks in high-risk patients. But they have no detectable effect on heart attacks in low-risk patients. However, this has not stopped the medical profession from recommending statins for millions of low-risk patients. The rationale is that if they are so clearly beneficial in high-risk patients, they are “probably” beneficial in low-risk patients.

I would argue a similar rationale should apply to supplements like coenzyme Q10.

Omega-3s:

This study found that omega-3 reduced both heart attacks and the risk of dying from heart disease. Most previous meta-analyses of omega-3s and heart disease have come to the same conclusion. However, some meta-analyses have failed to find any heart health benefits of omega-3s. Unfortunately, this has allowed both proponents and opponents of omega-3 use for heart health to quote studies supporting their viewpoint.

However, there is one meta-analysis that stands out from all the others. A group of 17 scientists from across the globe collaborated in developing a “best practices” experimental design protocol for assessing the effect of omega-3 supplementation on heart health. They conducted their clinical studies independently, and when their data (from 42,000 subjects) were pooled, the results showed that omega-3 supplementation decreased:

Premature death from all causes by 16%.
Premature death from heart disease by 19%.
Premature death from cancer by 15%.
Premature death from causes other than heart disease and cancer by 18%.

This study eliminates the limitations of previous meta-analyses. That makes it much stronger than the other meta-analyses. And these results are consistent with the current meta-analysis.

Omega-3s have long been recognized as essential nutrients. It is past time to set Daily Value (DV) recommendations for omega-3s. Based on the recommendations of other experts in the field, I think the DV should be set at 500-1,000 mg/day. I take more than that, but this would represent a good minimum recommendation for heart health.

Folic acid:

As with omega-3s, this meta-analysis reported a positive effect of folic acid on heart health. But many other studies have come up empty. Why is that?

It may be because, between food fortification and multivitamin use, many Americans already have sufficient blood levels of folic acid. For example, one study reported that 70% of the subjects in their study had optimal levels of folates in their blood. And that study also reported:

Subjects with adequate levels of folates in their blood received no additional benefit from folic acid supplementation.
However, for subjects with inadequate blood folate levels, folic acid supplementation decreased their risk of heart disease by ~15%.

We see this pattern over and over in supplement studies. Supplement opponents interpret these studies as showing that supplements are worthless. But a better interpretation is that supplements benefit those who need them.

The problem is that we don’t know our blood levels of essential nutrients. We don’t know which nutrients we need, and which we don’t. That’s why I like to think of supplements as “insurance” against the effects of an imperfect diet.

Vitamins E and D:

The situation with vitamins E and D is similar. This meta-analysis found no heart health benefit of either vitamin E or D. That is because the clinical studies included in the meta-analysis asked whether vitamin E or vitamin D improved heart health for everyone in the study.

Previous studies focusing on patients with low blood levels of these nutrients and/or at high risk of heart disease have shown some benefits of both vitamins at reducing heart disease risk.

So, for folic acid, vitamin E, and vitamin D (and possibly vitamin C) the take-home message should be:

Ignore all the Dr. Strangeloves telling you that these vitamins are “magic bullets” that will dramatically reduce your risk of heart disease.
Ignore the naysayers who tell you they are worthless.
Use supplementation wisely to make sure you have the recommended intake of these and other essential nutrients.

β-carotene:

This meta-analysis reported that β-carotene increased the risk of heart disease. This is not a new finding. Multiple previous studies have come to the same conclusion.

And we know why this is. There are many naturally occurring carotenoids, and they each have unique heart health benefits. A high dose β-carotene supplement interferes with the absorption of the other carotenoids. You are creating a deficiency of other heart-healthy carotenoids.

If you are not getting lots of colorful fruits and vegetables from your diet, my recommendation is to choose a supplement with all the naturally occurring carotenoids in balance – not a pure β-carotene supplement.

The Bottom Line

The Dr. Strangeloves in the nutrition space all have their favorite heart health supplements. They claim their supplements will single-handedly abolish heart disease (and help you leap tall buildings in a single bound).

On the other hand, many doctors will tell you these supplements are a waste of money. They don’t work. They just drain your wallet.

It’s so confusing. Who should you believe? Fortunately, a recent study has separated the hype from the hope and tells us which “heart-healthy” supplements work, and which don’t.

This study was a meta-analysis of 884 clinical studies with 883,627 participants. It reported:

Omega-3 supplementation deceased risk of heart attacks by 15% and all cardiovascular deaths by 7%.
Folic acid supplementation decreased stroke risk by 16%.
Coenzyme Q10 supplementation decreased the risk of all-cause mortality in patients with heart failure by 32%.
Vitamin C, vitamin E, vitamin D did not appear to affect heart disease outcomes.
β-carotene increased the risk of stroke, CVD mortality, and all-cause mortality.

For more details on this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Omega-3s And Congestive Heart Failure

May 3, 2022 by Dr. Steve Chaney

We Have Been Asking The Wrong Questions

Author: Dr. Stephen Chaney

Today’s Health Tip is a follow-up to the article I published last month on omega-3s and heart disease risk. In that article I pointed out the reasons why studies of the effect of omega-3s and heart disease risk have been so confusing.

One of the reasons is that many of the studies have been asking the wrong questions.

They were asking whether omega-3s reduced the risk of heart disease for everyone. Instead, they should have been asking who benefited from omega-3 supplementation.

They were asking whether omega-3s reduced the risk of all forms of heart disease combined. Instead, they should have been asking whether omega-3s reduced the risk of specific kinds of heart disease.

I also discussed a large clinical trial, the VITAL study, that was designed to answer those two questions.

The study I will describe today (L Djoussé et al, JACC Heart Failure, 10: 227-234, 2022) mined the data from the VITAL study to evaluate the effect of omega-3 supplementation on congestive heart failure, a form of heart disease that was not discussed in the VITAL study.

Everything You Need To Know About Congestive Heart Failure

Congestive heart failure is a killer. The term congestive heart failure simply means that your heart no longer pumps blood well. The initial symptoms are relatively non-specific and include things like.

Shortness of breath.
Fatigue and weakness.
Reduced ability to exercise.
Rapid or irregular heartbeat.
Persistent cough or wheezing.

However, as it progresses, the symptoms get much worse. Fluid builds up in your tissues.

Fluid buildup in your legs, ankles, and feet can make it difficult to walk.

Fluid buildup in your lungs makes it difficult to breathe. In advanced stages it can feel like you are drowning in a room full of air.

According to the CDC:

4 million Americans have congestive heart failure (CHF).

- It leads to ~380,000 deaths/year.

83% of patients diagnosed with CHF will be hospitalized at least once.

- 67% will be hospitalized two or more times.

CHF costs >$30 billion per year in health care costs and lost wages.

The risk of congestive heart failure is not spread evenly across the American population. Black Americans and Americans with type 2 diabetes are at increased risk.

According to the Framingham Heart Study:

Type 2 diabetes increases the risk of CHF 2-fold in men and 5-fold in women. The reasons are not entirely clear. However:

- High blood sugar is thought to either damage cells in heart muscle, weakening it, or damage small blood vessels within the heart, making it more difficult for the heart to pump blood.

- Some diabetes drugs that lower blood sugar also appear to increase the risk of congestive heart failure.

According to the CDC:

Black Americans are 2-fold more likely to develop CHF than White Americans. Again, the reasons are not clear. However:

- Some experts feel it could be due to the higher incidence of untreated high blood pressure in Black Americans.

In summary:

Congestive heart failure is a serious disease. Its symptoms affect your quality of life, and it can lead to hospitalizations and death.

Black Americans and Americans with type 2 diabetes are at higher risk of developing congestive heart failure.

How Was The Study Done?

The VITAL study, from which these data were extracted, was a placebo-controlled clinical trial designed to measure the effects of 1,000 mg omega-3 supplementation on the risk of developing heart disease. It enrolled 25,871 Americans aged 55 years or older and followed them for an average of 5.3 years.

The participants enrolled in the VITAL study represented a cross-section of the American population. Most were at low risk of heart disease, but there were subsets of the study group who were at higher risk of heart disease. A strength of the VITAL study was that it was designed so the high-risk subgroups could be evaluated separately.

The current study utilized data from the VITAL study to look at the effect of omega-3 supplementation on hospitalizations due to congestive heart failure. It also evaluated the effect of type 2 diabetes and race on the risk of hospitalizations.

Omega-3s And Congestive Heart Failure

When the investigators looked at the whole population, most of whom were at low-risk of congestive heart failure, they did not see any effect of omega-3 supplementation on the risk of hospitalizations due to congestive heart failure.

However, when they looked at high risk groups, the story was much different.

In patients with type-2 diabetes:

Omega-3 supplementation reduced the risk of the initial hospitalization for congestive heart failure by 31%

Omega-3 supplementation reduced the risk of multiple hospitalizations due to congestive heart failure by 47%.

The effect of omega-3 supplementation on hospitalizations was greatest for the Black participants in the study.

In the words of the authors, “Our data show beneficial effects of omega-3 fatty acid supplements on the incidence of heart failure hospitalizations in participants with type 2 diabetes but not in those without type 2 diabetes, and such benefit appeared to be stronger in Black participants with type 2 diabetes.”

We Are Asking The Wrong Questions

As I said above, there is so much confusion about the effect of omega-3s on heart disease because we scientists have been asking the wrong questions:

We have been asking whether omega-3s reduce the risk of heart disease for everyone. Instead, we should have been asking who benefits from omega-3 supplementation.

We have been asking whether omega-3s reduced the risk of all forms of heart disease combined. Instead, we should have been asking whether omega-3s reduced the risk of specific kinds of heart disease.

In my “Health Tip” last month I discussed a large clinical study, the VITAL study, that was specifically designed to answer the right questions. Like so many other studies it found that omega-3 supplementation did not significantly reduce the risk of all kinds of heart disease for everyone.

However, what it did find was more important than what it did not find:

When they looked at the effect of omega-3s on heart disease risk in high-risk groups, they found that major cardiovascular events were reduced by:

- 26% in African Americans.

- 26% in patients with type 2 diabetes.

- 17% in patients with a family history of heart disease.

- 19% in patients with two or more risk factors of heart disease.

When they looked at the effect of omega-3s on heart disease risk in people with low omega-3 intake, they found that omega-3 supplementation reduced major cardiovascular events by:

- 19% in patients with low fish intake.

When they looked at the effect of omega-3s on the risk of different forms of heart disease, they found that omega-3 supplementation reduced:

- Heart attacks by 28% in the general population and by 70% for African Americans.

- Deaths from heart attacks by 50%.

- Deaths from coronary heart disease (primarily heart attacks and ischemic strokes (strokes caused by blood clots)) by 24%.

In other words, when they asked the wrong questions, they got the wrong answer. If they had just looked at the effect of omega-3 supplementation on all forms of heart disease for everyone (like most other omega-3 studies), they would have concluded that omega-3s are worthless.

However, when they asked the right questions, they found that omega-3s were very beneficial for high-risk populations and for certain types of heart disease.

The current study utilized the same data to analyze the effect of omega-3 supplementation on hospitalizations due to congestive heart failure. And the results were similar.

If they had asked the wrong question, “Does omega-3 supplementation reduce congestive heart failure hospitalizations for everyone?”, they would have concluded that omega-3 supplementation was worthless.

However, instead they asked, “Does omega-3 supplementation reduce congestive heart failure hospitalizations for certain high-risk groups” and were able to show that omega-3 supplementation significantly reduced congestive heart failure hospitalizations for people with type 2 diabetes and for Blacks.

We need to change the paradigm for clinical studies of supplements. The old paradigm asks the wrong questions. If we really want to know the role of supplementation for our health, we need to start asking the right questions.

The Bottom Line

There is perhaps nothing more confusing to the average person than the “truth” about omega-3 supplementation and heart disease risk. Much of the confusion is because we have been asking the wrong questions:

We have been asking whether omega-3 supplementation reduces the risk of heart disease for everyone. Instead, we should have been asking who benefits from omega-3 supplementation.

We have been asking whether omega-3 supplementation reduces the risk of all forms of heart disease combined. Instead, we should have been asking whether omega-3 supplementation reduces the risk of specific kinds of heart disease.

A recent study on the effect of omega-3 supplementation on hospitalizations due to heart disease is a perfect example.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.