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Nut consumption and risk of heart failure in the Physicians' Health Study I^1,2,3

¹ From the Divisions of Aging (LD, TR, and JMG) and Preventive Medicine (JMG), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA

Background: Heart failure is highly prevalent among older adults and is associated with high cost and societal burden. Although previous studies have reported beneficial effects of dietary factors on heart failure predictors, no previous study has examined whether frequent consumption of nuts is associated with a lower risk of heart failure in a large prospective cohort.

Objective: We examined the association between nut consumption and incident heart failure to determine whether such a relation is modified by overweight or obesity.

Design: This was a prospective cohort study of 20 976 participants from the Physicians' Health Study I. Nut consumption was assessed with a simple abbreviated food questionnaire, and self-reported heart failure was ascertained by follow-up questionnaires. We used Cox regression to estimate relative risks of heart failure.

Results: After an average follow-up of 19.6 y, 1093 new cases of heart failure occurred. Nut consumption was not associated with the risk of developing heart failure in this cohort: multivariable adjusted hazard ratios were 1.0 (reference), 0.98 (95% CI: 0.83, 1.15), 1.06 (95% CI: 0.89, 1.27), and 1.01 (95% CI: 0.84, 1.22) for nut consumption of <1, 1, and 2 servings/wk, respectively (P for linear trend: 0.64). The lack of a meaningful relation between nut intake and incident heart failure was seen in both lean and overweight or obese participants (P for interaction: 0.96).

Conclusion: Our data do not provide evidence for an association between nut consumption and incident heart failure in US male physicians. However, our data cannot rule out possible benefits of nut consumption on subtypes of heart failure not prevalent in this cohort.