CoChat
Sign Up
Cited by 227Nutritional Studies and DietSodium Intake and HealthHeart Failure Treatment and Management

Consistency With the DASH Diet and Incidence of Heart Failure

Open access
Levitan, Emily B., Wolk, Alicja, Mittleman, Murray A.·2009·Archives of Internal Medicine
DOI 10.1001/archinternmed.2009.56PMC PMC2682222
Open this paper in CoChat — free account

Abstract

BACKGROUND: The Dietary Approaches to Stop Hypertension (DASH) diet effectively reduces blood pressure. In observational studies, the association between diets consistent with DASH and risk of coronary heart disease and stroke has been examined with varying results. We hypothesized that diets consistent with the DASH diet would be associated with a lower incidence of heart failure (HF). METHODS: We conducted a prospective observational study in 36 019 participants in the Swedish Mammography Cohort who were aged 48 to 83 years and without baseline HF, diabetes mellitus, or myocardial infarction. Diet was measured using food-frequency questionnaires. We created a score to assess consistency with the DASH diet by ranking the intake of DASH diet components and 3 additional scores based on food and nutrient guidelines. Cox proportional hazards models were used to calculate rate ratios of HF-associated hospitalization or death, determined using the Swedish inpatient and cause-of-death registers between January 1, 1998, and December 31, 2004. RESULTS: During 7 years, 443 women developed HF. Women in the top quartile of the DASH diet score based on ranking DASH diet components had a 37% lower rate of HF after adjustment for age, physical activity, energy intake, education status, family history of myocardial infarction, cigarette smoking, postmenopausal hormone use, living alone, hypertension, high cholesterol concentration, body mass index (calculated as weight in kilograms divided by height in meters squared), and incident myocardial infarction. Rate ratios (95% confidence intervals) across quartiles were 1 [Reference], 0.85 (0.66-1.11), 0.69 (0.54-0.88), and 0.63 (0.48-0.81); P(trend) < .001. A similar pattern was seen for the guideline-based scores. CONCLUSION: In this population, diets consistent with the DASH diet are associated with lower rates of HF.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/archinternmed.2009.56

Cites

5 of 5 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Early primary prevention strategies and treatment of associated risk factors reduce incident, symptomatic heart failure.

    “Early primary prevention strategies and treatment of associated risk factors reduce incident, symptomatic heart failure and should include lifestyle intervention with nutrition, physical activity, weight management, and smoking cessation (271-274) (Fig. 10.6).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [274]

    The Introduction (page not provided) discusses preventing heart failure through treatment and lifestyle interventions targeting risk factors, and the Abstract Conclusions report lower heart-failure rates among people whose diets were consistent with DASH. But the study reports an association, not that early prevention or risk-factor treatment reduces incident symptomatic heart failure; it also did not assess when prevention began. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Early primary prevention strategies and treatment of associated risk factors reduce incident, symptomatic heart failure.

    “Early primary prevention strategies and treatment of associated risk factors reduce incident, symptomatic heart failure and should include lifestyle intervention with nutrition, physical activity, weight management, and smoking cessation (268–271) (Fig. 10.5).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [271]

    The Introduction discusses preventing heart failure through treatment and lifestyle measures targeting risk factors, and the Abstract Conclusions report that diets consistent with DASH were associated with lower heart-failure rates. But this observational finding does not establish that prevention strategies or risk-factor treatment reduce symptomatic heart failure; the paper also does not test physical activity, weight management, or smoking cessation as interventions. The Comment notes that its outcome captures heart failure resulting in hospitalization or death. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 33

  1. [1]Schocken DD Benjamin EJ Fonarow GC Prevention of heart failure: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group Circulation 2008 117 2544 2565 18391114
  2. [2]Appel LJ Moore TJ Obarzanek E A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group N Engl J Med 1997 336 1117 1124 9099655
  3. [3]Obarzanek E Sacks FM Vollmer WM Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hypertension (DASH) Trial Am J Clin Nutr 2001 74 80 89 11451721
  4. [5]Karanja NM Obarzanek E Lin PH Descriptive characteristics of the dietary patterns used in the Dietary Approaches to Stop Hypertension Trial. DASH Collaborative Research Group J Am Diet Assoc 1999 99 8 Suppl S19 27 10450290
  5. [7]Fung TT Chiuve SE McCullough ML Rexrode KM Logroscino G Hu FB Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women Arch Intern Med 2008 168 713 720 18413553
  6. [9]Wolk A Larsson SC Johansson JE Ekman P Long-term fatty fish consumption and renal cell carcinoma incidence in women JAMA 2006 296 1371 1376 16985229
  7. [13]Ingelsson E Arnlov J Sundstrom J Lind L The validity of a diagnosis of heart failure in a hospital discharge register Eur J Heart Fail 2005 7 787 791 15916919
  8. [17]Thurston SW Eisen EA Schwartz J Smoothing in survival models: an application to workers exposed to metalworking fluids Epidemiology 2002 13 685 692 12410010
  9. [18]Dauchet L Kesse-Guyot E Czernichow S Dietary patterns and blood pressure change over 5-y follow-up in the SU.VI.MAX cohort Am J Clin Nutr 2007 85 1650 1656 17556705
  10. [19]Obarzanek E Vollmer WM Lin PH Effects of individual components of multiple behavior changes: the PREMIER trial Am J Health Behav 2007 31 545 560 17555385
  11. [22]Akesson A Weismayer C Newby PK Wolk A Combined effect of low-risk dietary and lifestyle behaviors in primary prevention of myocardial infarction in women Arch Intern Med 2007 167 2122 2127 17954808
  12. [23]Chess DJ Stanley WC Role of diet and fuel overabundance in the development and progression of heart failure Cardiovasc Res 2008 79 269 278 18343896
  13. [24]Djousse L Gaziano JM Breakfast cereals and risk of heart failure in the Physicians' Health Study I Arch Intern Med 2007 167 2080 2085 17954802
  14. [25]Djousse L Gaziano JM Egg consumption and risk of heart failure in the Physicians' Health Study Circulation 2008 117 512 516 18195171 PMC2706003
  15. [26]He J Ogden LG Bazzano LA Vupputuri S Loria C Whelton PK Dietary sodium intake and incidence of congestive heart failure in overweight US men and women: first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study Arch Intern Med 2002 162 1619 1624 12123406
  16. [27]Djousse L Rudich T Gaziano JM Nut consumption and risk of heart failure in the Physicians' Health Study I Am J Clin Nutr 2008 88 930 933 18842778 PMC2574424
  17. [28]Chicco AJ Sparagna GC McCune SA Linoleate-rich high-fat diet decreases mortality in hypertensive heart failure rats compared with lard and low-fat diets Hypertension 2008 52 549 555 18663155 PMC2864132
  18. [29]Okere IC Chess DJ McElfresh TA High-fat diet prevents cardiac hypertrophy and improves contractile function in the hypertensive dahl salt-sensitive rat Clin Exp Pharmacol Physiol 2005 32 825 831 16173943
  19. [30]Sharma N Okere IC Duda MK High fructose diet increases mortality in hypertensive rats compared to a complex carbohydrate or high fat diet Am J Hypertens 2007 20 403 409 17386347
  20. [31]Haider AW Larson MG Franklin SS Levy D Systolic blood pressure, diastolic blood pressure, and pulse pressure as predictors of risk for congestive heart failure in the Framingham Heart Study Ann Intern Med 7 2003 138 10 16 12513039
  21. [32]Konhilas JP Leinwand LA The effects of biological sex and diet on the development of heart failure Circulation 2007 116 2747 2759 18056540
  22. [33]Most MM Estimated phytochemical content of the dietary approaches to stop hypertension (DASH) diet is higher than in the Control Study Diet J Am Diet Assoc 2004 104 1725 1727 15499362
  23. [34]Lopes HF Martin KL Nashar K Morrow JD Goodfriend TL Egan BM DASH diet lowers blood pressure and lipid-induced oxidative stress in obesity Hypertension 2003 41 422 430 12623938
  24. [35]Schaufelberger M Swedberg K Koster M Rosen M Rosengren A Decreasing one-year mortality and hospitalization rates for heart failure in Sweden; Data from the Swedish Hospital Discharge Registry 1988 to 2000 Eur Heart J 2004 25 300 307 14984918
  25. [36]Roger VL Weston SA Redfield MA Trends in heart failure incidence and survival in a community-based population JAMA 2004 292 344 350 15265849
  26. [37]Gottdiener JS Arnold AM Aurigemma GP Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study J Am Coll Cardiol 2000 35 1628 1637 10807470
  27. [38]Hunt SA Abraham WT Chin MH ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article Circulation 2005 112 1825 1852 16160202
  28. [39]McCullough PA Philbin EF Spertus JA Kaatz S Sandberg KR Weaver WD Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study J Am Coll Cardiol 2002 39 60 69 11755288
  29. [40]Messerer M Johansson SE Wolk A The validity of questionnaire-based micronutrient intake estimates is increased by including dietary supplement use in Swedish men J Nutr 2004 134 1800 1805 15226472
  30. [41]Larsson SC Hakansson N Naslund I Bergkvist L Wolk A Fruit and vegetable consumption in relation to pancreatic cancer risk: a prospective study Cancer Epidemiol Biomarkers Prev 2006 15 301 305 16492919
  31. [42]Larsson SC Giovannucci E Bergkvist L Wolk A Whole grain consumption and risk of colorectal cancer: a population-based cohort of 60,000 women Br J Cancer 2005 92 1803 1807 15827552 PMC2362029
  32. [43]Larsson SC Bergkvist L Wolk A Milk and lactose intakes and ovarian cancer risk in the Swedish Mammography Cohort Am J Clin Nutr 2004 80 1353 1357 15531686
  33. [44]Larsson SC Bergkvist L Wolk A Consumption of sugar and sugar-sweetened foods and the risk of pancreatic cancer in a prospective study Am J Clin Nutr 2006 84 1171 1176 17093171

Cited by

Sorted by citations

Authors
Levitan, E. B., Wolk, A., & Mittleman, M. A.
Affiliations
Beth Israel Deaconess Medical Center (US)
ORCID
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2009-05-11
Volume
169
Issue
9
Pages
851
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinternmed.2009.56
PMC
PMC2682222
OpenAlex
W2011774553
Cited by
227
References
5
Citations by year
2026: 6 · 2025: 10 · 2024: 17 · 2023: 13 · 2022: 20 · 2021: 11 · 2020: 14 · 2019: 18 · 2018: 13 · 2017: 10 · 2016: 10 · 2015: 9 · 2014: 7 · 2013: 19 · 2012: 15
FWCI
16.47
Type
journal article
Language
en
Open access
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Swedish Foundation for International Cooperation in Research and Higher Education
  • Vetenskapsrådet
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (F32HL091683)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
DASH diet, heart failure, dietary adherence, heart failure incidence, heart failure hospitalization, heart failure mortality, women, hypertension, coronary artery disease
MeSH terms
Aged, Aged, 80 and over, Diet, Diet Surveys, Female, Follow-Up Studies, Heart Failure, Humans, Hypertension, Male, Middle Aged, Nutritional Requirements, Prospective Studies, Risk Factors, Sweden, Incidence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review