Advertisement

Healthy diet reduces markers of cardiac injury and inflammation regardless of macronutrients: Results from the OmniHeart trial

  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Lara C. Kovell
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Affiliations
    Division of Cardiology, University of Massachusetts Medical School, Worcester, MA, United States of America
    Search for articles by this author
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Edwina H. Yeung
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Affiliations
    Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States of America
    Search for articles by this author
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Edgar R. Miller III
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Affiliations
    Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, United States of America
    Search for articles by this author
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Lawrence J. Appel
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Affiliations
    Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, United States of America
    Search for articles by this author
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Robert H. Christenson
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Affiliations
    Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States of America
    Search for articles by this author
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Heather Rebuck
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Affiliations
    Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States of America
    Search for articles by this author
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Steven P. Schulman
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Affiliations
    Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
    Search for articles by this author
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Stephen P. Juraschek
    Correspondence
    Corresponding author at: Beth Israel Deaconess Medical Center, Harvard Medical School, Division of General Medicine, Section for Research, 330 Brookline Avenue, CO-1309, #216, Boston, MA 02215, United States of America.
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.
    Affiliations
    Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
    Search for articles by this author
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussion interpretation.

      Highlights

      • Three healthy diets led to reduction in high-sensitivity troponin, a marker of subclinical cardiac injury.
      • Inflammation, measured by high-sensitivity CRP, was also reduced by all three healthy diets.
      • These changes were not explained alone by improvement in hypertension or hyperlipidemia.
      • All three healthy diets can be recommended to help reduce cardiovascular risk.

      Abstract

      Background

      Despite diet being a first-line strategy for preventing cardiovascular disease, the optimal macronutrient profile remains unclear. We studied the effects of macronutrient profile on subclinical cardiovascular injury and inflammation.

      Methods

      OmniHeart was a randomized 3-period, crossover feeding study in 164 adults with high blood pressure or hypertension (SBP 120–159 or DBP 80–99 mm Hg). Participants were fed each of 3 diets (emphasizing carbohydrate (CARB), protein (PROT), or unsaturated fat (UNSAT)) for 6-weeks, with feeding periods separated by a washout period. Weight was held constant. Fasting serum was collected at baseline while participants ate their own diets and after each feeding period. High-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity C-reactive protein (hs-CRP) were measured in stored specimens.

      Results

      The average age was 53.6 years, 55% were African American, and 45% were women. At baseline, the median (25th-percentile, 75th-percentile) hs-cTnI was 3.3 ng/L (1.9, 5.6) and hs-CRP was 2.2 mg/L (1.1, 5.2). Compared to baseline, all 3 diets reduced hs-cTnI: CARB –8.6% (95%CI: −16.1, −0.4), PROT –10.8% (−18.4, −2.5), and UNSAT −9.4% (−17.4, −0.5). Hs-CRP was similarly changed by −13.9 to −17.0%. Hs-cTnI and hs-CRP reductions were of similar magnitudes as SBP and low-density lipoprotein cholesterol (LDLc) but were not associated with these risk-factor reductions (P-values = 0.09). There were no between-diet differences in hs-cTnI and hs-CRP reductions.

      Conclusions

      Healthy diet, regardless of macronutrient emphasis, directly mitigated subclinical cardiac injury and inflammation in a population at risk for cardiovascular disease. These findings support dietary recommendations emphasizing healthy foods rather than any one macronutrient.
      Trial Registration: This trial is registered at clinicaltrials.gov, number: NCT00051350; URL: https://clinicaltrials.gov/ct2/show/NCT00051350.

      Abbreviations:

      CARB (the OmniHeart carbohydrate feeding period), CI (confidence interval), CVD (cardiovascular disease), eGFR (estimated glomerular filtration rate), DBP (diastolic blood pressure), BMI (body mass index), LDLc (low-density lipoprotein cholesterol), DASH (Dietary Approaches to Stop Hypertension), GEE (generalized estimating equation), hs-cTnI (high-sensitivity cardiac troponin I), hs-cTnT (high-sensitivity cardiac troponin T), hs-CRP (high-sensitivity C-reactive protein), MI (myocardial infarction), OmniHeart (Optimal Macronutrient Intake Trial to Prevent Heart Disease), PROT (the OmniHeart protein feeding period), SBP (systolic blood pressure), SD (standard deviation), UNSAT (the OmniHeart unsaturated fat feeding period)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Benjamin E.J.
        • Virani S.S.
        • Callaway C.W.
        • et al.
        Heart disease and stroke statistics-2018 update: a report from the American Heart Association.
        Circulation. 2018; https://doi.org/10.1161/CIR.0000000000000558
        • Whelton P.K.
        • Carey R.M.
        • Aronow W.S.
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.
        J. Am. Coll. Cardiol. 2017; https://doi.org/10.1016/j.jacc.2017.11.005
        • Eckel R.H.
        • Jakicic J.M.
        • Ard J.D.
        • et al.
        2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2014; 63: 2960-2984
        • Look AHEAD Research Group
        • Wing R.R.
        • Bolin P.
        • et al.
        Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.
        N. Engl. J. Med. 2013; 369: 145-154
        • Appel L.J.
        • Champagne C.M.
        • Harsha D.W.
        • et al.
        Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial.
        JAMA. 2003; 289: 2083-2093
        • Appel L.J.
        • Sacks F.M.
        • Carey V.J.
        • et al.
        Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial.
        JAMA. 2005; 294: 2455-2464
        • Arnett D.K.
        • Blumenthal R.S.
        • Albert M.A.
        • et al.
        ACC/AHA guideline on the primary prevention of cardiovascular disease.
        Circulation. 2019; 2019CIR0000000000000678https://doi.org/10.1161/CIR.0000000000000678
        • Rehm C.D.
        • Peñalvo J.L.
        • Afshin A.
        • Mozaffarian D.
        Dietary intake among US adults, 1999–2012.
        JAMA. 2016; 315: 2542-2553
        • Zhang F.F.
        • Liu J.
        • Rehm C.D.
        • Wilde P.
        • Mande J.R.
        • Mozaffarian D.
        Trends and disparities in diet quality among US adults by supplemental nutrition assistance program participation status.
        JAMA Netw. Open. 2018; 1: e180237
        • Ludwig D.S.
        • Willett W.C.
        • Volek J.S.
        • Neuhouser M.L.
        Dietary fat: from foe to friend?.
        Science. 2018; 362: 764-770
        • Erlinger T.P.
        • Miller E.R.
        • Charleston J.
        • Appel L.J.
        Inflammation modifies the effects of a reduced-fat low-cholesterol diet on lipids: results from the DASH-sodium trial.
        Circulation. 2003; 108: 150-154
        • Juraschek S.P.
        • Miller E.R.
        • Selvin E.
        • et al.
        Effect of type and amount of dietary carbohydrate on biomarkers of glucose homeostasis and C reactive protein in overweight or obese adults: results from the OmniCarb trial.
        BMJ Open Diabetes Res. Care. 2016; 4e000276
        • Park K.C.
        • Gaze D.C.
        • Collinson P.O.
        • Marber M.S.
        Cardiac troponins: from myocardial infarction to chronic disease.
        Cardiovasc. Res. 2017; https://doi.org/10.1093/cvr/cvx183
        • McEvoy J.W.
        • Lazo M.
        • Chen Y.
        • et al.
        Patterns and determinants of temporal change in high-sensitivity cardiac troponin-T: the Atherosclerosis Risk in Communities Cohort Study.
        Int. J. Cardiol. 2015; 187: 651-657
        • Pokharel Y.
        • Sun W.
        • Villareal D.T.
        • et al.
        Association between high-sensitivity troponin T and cardiovascular risk in individuals with and without metabolic syndrome: the ARIC study.
        Eur. J. Prev. Cardiol. 2017; 24: 628-638
        • Goff D.C.
        • Lloyd-Jones D.M.
        • Bennett G.
        • et al.
        2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2014; 129: S49-S73
        • Danesh J.
        • Wheeler J.G.
        • Hirschfield G.M.
        • et al.
        C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease.
        N. Engl. J. Med. 2004; 350: 1387-1397
        • Ridker P.M.
        • MacFadyen J.G.
        • Everett B.M.
        • et al.
        Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: a secondary analysis from the CANTOS randomised controlled trial.
        Lancet. 2018; 391: 319-328
        • Carey V.J.
        • Bishop L.
        • Charleston J.
        • et al.
        Rationale and design of the optimal macro-nutrient intake heart trial to prevent heart disease (OMNI-heart).
        Clin Trials. 2005; 2: 529-537
        • Kavsak P.A.
        • Worster A.
        • Hill S.A.
        • Jaffe A.S.
        Evaluation of the Siemens ADVIA centaur high-sensitivity cardiac troponin I assay in serum.
        Clin. Chim. Acta. 2018; 487: 216-221
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin. Chem. 1972; 18: 499-502
        • McEvoy J.W.
        • Chen Y.
        • Ndumele C.E.
        • et al.
        Six-year change in high-sensitivity cardiac troponin T and risk of subsequent coronary heart disease, heart failure, and death.
        JAMA Cardiol. 2016; 1: 519-528
        • Daniels L.B.
        • Clopton P.
        • deFilippi C.R.
        • et al.
        Serial measurement of N-terminal pro–B-type natriuretic peptide and cardiac troponin T for cardiovascular disease risk assessment in the Multi-Ethnic Study of Atherosclerosis (MESA).
        Am. Heart J. 2015; 170: 1170-1183
        • Ford I.
        • Shah A.S.V.
        • Zhang R.
        • et al.
        High-sensitivity cardiac troponin, statin therapy, and risk of coronary heart disease.
        J. Am. Coll. Cardiol. 2016; 68: 2719-2728
        • Fretz A.
        • McEvoy J.W.
        • Rebholz C.M.
        • et al.
        Relation of lifestyle factors and life's simple 7 score to temporal reduction in troponin levels measured by a high-sensitivity assay (from the atherosclerosis risk in communities study).
        Am. J. Cardiol. 2017; https://doi.org/10.1016/j.amjcard.2017.11.017
        • Srivastava P.K.
        • Pradhan A.D.
        • Cook N.R.
        • Ridker P.M.
        • Everett B.M.
        Impact of modifiable risk factors on B-type natriuretic peptide and cardiac troponin T concentrations.
        Am. J. Cardiol. 2016; 117: 376-381
        • Masson S.
        • Marchioli R.
        • Mozaffarian D.
        • et al.
        Plasma n-3 polyunsaturated fatty acids in chronic heart failure in the GISSI-Heart Failure Trial: relation with fish intake, circulating biomarkers, and mortality.
        Am Heart J. 2013; 165: 208-215.e4
        • Ha V.
        • Viguiliouk E.
        • Kendall C.W.C.
        • et al.
        Effect of a low glycemic index diet versus a high-cereal fibre diet on markers of subclinical cardiac injury in healthy individuals with type 2 diabetes mellitus: an exploratory analysis of a randomized dietary trial.
        Clin. Biochem. 2017; 50: 1104-1109
        • Wang A.
        • Liu J.
        • Li C.
        • et al.
        Cumulative exposure to high-sensitivity C-reactive protein predicts the risk of cardiovascular disease.
        J. Am. Heart Assoc. 2017; 6e005610
      1. Ridker PM., Everett BM., Thuren T., et al. Antiinflammatory Therapy With Canakinumab for Atherosclerotic Disease. Doi: https://doi.org/10.1056/NEJMoa1707914.

        • Brighenti F.
        • Valtueña S.
        • Pellegrini N.
        • et al.
        Total antioxidant capacity of the diet is inversely and independently related to plasma concentration of high-sensitivity C-reactive protein in adult Italian subjects.
        Br. J. Nutr. 2005; 93: 619-625
        • Waldeyer C.
        • Brunner F.J.
        • Braetz J.
        • et al.
        Adherence to Mediterranean diet, high-sensitive C-reactive protein, and severity of coronary artery disease: contemporary data from the INTERCATH cohort.
        Atherosclerosis. 2018; 275: 256-261
        • Lahoz C.
        • Castillo E.
        • Mostaza J.M.
        • et al.
        Relationship of the Adherence to a Mediterranean Diet and Its Main Components with CRP Levels in the Spanish Population.
        Nutrients. 2018; : 10(3)https://doi.org/10.3390/nu10030379
        • Esposito K.
        • Pontillo A.
        • Di Palo C.
        • et al.
        Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial.
        JAMA. 2003; 289: 1799-1804
        • Soltani S.
        • Chitsazi M.J.
        • Salehi-Abargouei A.
        The effect of dietary approaches to stop hypertension (DASH) on serum inflammatory markers: a systematic review and meta-analysis of randomized trials.
        Clin. Nutr. 2018; 37: 542-550
        • Azadbakht L.
        • Izadi V.
        • Surkan P.J.
        • Esmaillzadeh A.
        Effect of a high protein weight loss diet on weight, high-sensitivity C-reactive protein, and cardiovascular risk among overweight and obese women: a parallel clinical trial.
        Int. J. Endocrinol. 2013; 2013: 971724
        • Gardner C.D.
        • Trepanowski J.F.
        • Del Gobbo L.C.
        • et al.
        Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the DIETFITS randomized clinical trial.
        JAMA. 2018; 319: 667-679
        • de Souza R.J.
        • Swain J.F.
        • Appel L.J.
        • Sacks F.M.
        Alternatives for macronutrient intake and chronic disease: a comparison of the OmniHeart diets with popular diets and with dietary recommendations.
        Am. J. Clin. Nutr. 2008; 88: 1-11
        • Lee-Kwan S.H.
        • Moore L.V.
        • Blanck H.M.
        • Harris D.M.
        • Galuska D.
        Disparities in State-Specific Adult Fruit and Vegetable Consumption - United States, 2015.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 1241-1247
        • Ikeda N.
        • Torii R.
        When does atherosclerosis become irreversible? Chronological change from an early to an advanced atherosclerotic lesion observed by angioscopy.
        Angiology. 2005; 56: 361-370
        • Rose G.
        Sick individuals and sick populations.
        Int. J. Epidemiol. 2001; 30: 427-432