The role of diets in the pathogenesis of cardiac dysfunction is controversial. However, it is well known that Western diet causes oxidative stress and has pro-inflammatory effects, whereas Mediterranean style diets are anti-inflammatory. Recently, cohort studies and case control studies, have demonstrated that western style diets rich in sugar and physical inactivity with obesity are important behavioural risk factors of heart failure. Pre-heart failure may be defined as a state of myocardial dysfunction, which is at high risk for developing complete heart failure. It is similar to pre-diabetes or pre-hypertension for developing diabetes mellitus and hypertension, respectively. Pre-heart failure is characterised with changes in cardiac muscles that are known as remodelling which may help to keep the blood pumping, but the ventricular walls may eventually weaken and are not able to pump adequate blood to the circulatory system resulting in to chronic heart failure. The heart may have high filling pressure with symptoms of dyspnoea and other congestive symptoms. In this process, aldosterone and cortisol predict medium-term left ventricular remodelling in an attempt to prevent cardiac failure. In the pathophysiology of cardiomyocyte dysfunction as well as in the conversion of physiological remodelling to pathological remodelling and pre-heart failure to complete heart failure, behavioural risk factors have important role. In previous studies, Dhalla et al. have observed subcellular remodelling and alterations in sarcoplasmic reticulum to be important which could be identified early by speckle tracking echocardiography. In view of the rapid increase in the burden of heart failure in the developed and developing countries, and unmet needs in the early diagnosis and treatment, it is important to find out new risk factors and methods for identification of heart failure in early stage of pre-heart failure. This analysis, re-examines, the role of nutritional factors as unmet needs in the pathogenesis and management of heart failure. This meta-analysis included data from three randomized, controlled single blind trials, published earlier, The intervention and control groups were compared for behavioural risk factors, food intakes, fatty acid intake and on ratio of polyunsaturated fatty acid(PUFA)/flavonoid intake respectively in the two groups (n = 1446 vs 1320).The criteria for the diagnosis of pre-heart failure and heart failure were electrocardiographic and radiological increase in size of the heart. Effects of Indo-Mediterranean style foods on parameters of pre-heart failure and heart failure and arrhythmias were significantly lower in the intervention group compared to control group. At baseline all the parameters of heart failure showed no significant differences, between intervention and control group. However, after a follow up of two years, left ventricular strain (Odds Ratio 0.57 (P < 0.01), left ventricular hypertrophy (OD 0.69, CI 0.64 - 0.75, P < 0.01), as well as, NYHA class II-IV heart failure (OR 0.59, P < 0.05) were significantly lower in the intervention group compared to control group. Incidence of cardiac arrhythmias were also significantly lower in the intervention group compared to control group (OR 0.49; P < 0.01). It is possible that treatment with Indo-Mediterranean style diets can cause significant decline in pre-heart failure, heart failure as well as in arrhythmias, possibly due to the anti-inflammatory effects of such diets, which may be important mechanisms for reduction in cardiovascular mortality in patients with recent myocardial infarction and high risk of cardiovascular diseases.
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