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High-Protein Diet Reduces Cardiometabolic Risk Among Patients With Heart Failure


Compared with a standard-protein diet, a high-protein diet reduced several markers of cardiometabolic risk in patients with heart failure and diabetes who were considered overweight or obese.

Compared with a standard-protein diet, a high-protein diet reduced several markers of cardiometabolic risk in 76 patients with heart failure (HF) who were considered overweight or obese, according to trial results published in ESC Heart Failure.

The markers evaluated in the randomized controlled study included glycosylated hemoglobin, cholesterol, and triglyceride levels. Systolic and diastolic blood pressure (BP) also improved.

Similar results were seen among patients with diabetes, in that insulin sensitivity improved among those with type 2 diabetes and postprandial blood glucose and insulinemia levels dropped among patients with either type.

“Common mechanism ties many co-morbidities to HF by initiating or exacerbating chronic inflammation and activating the sympathetic renin–angiotensin–aldosterone systems,” the authors noted. “However, less is known about the complex physiological interplay of multiple co-morbidities to each other and HF.”

Among the mostly male (72.4%) and White (51.4%) patients, whose mean (SD) weight was 107.8 (20.8) kg—237.7 (45.9) lb—and mean age was 57.7 (9.7) years, follow-up evaluations were conducted after 3 months and the results compared with baseline measures. These showed similar overall improvements regarding total weight and waist circumference reductions for the 2 diet types, according to the authors.

Weight losses of 3.6 kg (7.9 lb) and 2.9 kg (6.4 lb) were seen for the patients with HF in the high-protein (n = 33) and standard-protein (n = 43) groups, respectively, and weight circumferences decreased by 1.9 cm (0.74 in) and 1.3 cm (0.5 in).

Differences were more apparent when effects on glycosylated hemoglobin, cholesterol, triglycerides, and BP were considered for the high- and standard-protein diets, respectively, and showed the former was “more effective in reducing cardiometabolic risk in this population”:

  • Glycosylated hemoglobin: 0.7% vs 0.1% (P = .002)
  • Cholesterol: 16.8 vs 0.9 mg/dL (P = .031)
  • Triglycerides: 25.7 vs 5.7 mg/dL (P = .032)
  • Systolic BP at baseline and 3 months (P < .001):
    • High-protein group: 123.3 (12.8) and 112.5 (11.8) mm Hg
    • Standard-protein group: 116.8 (19.5) and 117.5 (15.7) mm Hg
  • Diastolic BP at baseline and 3 months (P = .040):
    • High-protein group: 72.8 (9.6) and 65.2 (8.1) mm Hg
    • Standard-protein group: 73.3 (1.0) and 70.1 (6.9) mm Hg

Differences between the 2 types of cholesterol, low-density and high-density lipoprotein, were not seen, which the authors attribute to their short study period. “Improvements in these parameters are typically correlated with weight loss that has been maintained for more than 3 months.”

The high-protein diet consisted of 30% protein (110 g/d), 40% carbohydrates (150 g/d), and 30% fat (50 g/d), and the standard-protein diet, 15% protein (55 g/d), 55% carbohydrates (200 g/d), and 30% fat (50 g/d). Trial participants received 2 regular, energy-restricted meal plans (1200 or 1500 kcal/d) based on their assessed calorie deficit, with goals of reducing daily kilocalorie intake by 500 to 800 and weekly weight loss of 0.5 kg (1.1 lb) to 1.0 kg (2.2 lb).

With an mean ejection fraction of 38.5% (10.7%), most patients were suffering from HF with reduced ejection fraction. They also presented with New York Heart Association functional class II (77.6%) or class III (22.4%) disease.

“Given the evidence that visceral and ectopic adiposities adversely affect inflammatory and metabolic changes, haemodynamic disorders, and left ventricular diastolic and systolic dysfunction, nutrition’s potential role in reducing cardiometabolic risks and slowing disease progression is particularly relevant and timely,” the authors concluded. “To our knowledge, our study is the first to investigate the impact of macronutrients on HF outcomes in overweight and obese patients with HF and diabetes.”

They recommend that future studies consider protein’s role in glucose control, insulin regulation, and weight and visceral fat loss; barriers to weight loss among overweight and obese individuals; the integration of weight-loss initiatives into community-based models; and how high-protein diets affect a more diverse patient population.


Evangelista LS, Jose MM, Sallam H, et al. High-protein vs. standard-protein diets in overweight and obese patients with heart failure and diabetes mellitus: findings of the Pro-HEART trial. ESC Heart Fail. Published online January 27, 2021. doi:10.1002/ehf2.13213

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