Routine Periodic Fasting Is Associated with a Lower Risk of Inpatient Hospitalization for the Primary Diagnosis of Heart Failure Following Covid-19 Diagnosis

ABSTRACT

Background Intermittent fasting modulates inflammation and reduces cardiometabolic risks, even without weight loss. Many Utahns (30%) engage in routine periodic fasting, primarily for religious purposes (1 day/month for?>40 years). Periodic fasting is associated with greater longevity, lower incidence of heart failure (HF) and diabetes, and lower COVID-19 severity. This study evaluated the association of periodic fasting with inpatient hospitalization (hosp.) for the primary diagnosis of HF after COVID-19 diagnosis. Methods Patients undergoing cardiac catheterization at Intermountain Healthcare from 2/2013-3/2020 were enrolled in the INSPIRE registry (NCT02450006) and provided survey data for periodic fasting (n=5,795). Between March 6, 2020 and April 8, 2022, COVID-19 was diagnosed in N=464 (1852 COVID-negative, 3466 no test, 13 fasted routinely <5 years). Subjects were followed to April 17, 2022 for HF hosp., mortality, MI, revascularization, and stroke. Results Periodic fasting was reported by 135 (29.1%) of the 464 subjects and they had fasted routinely for 42.7+/-19.0 years (min 7 years, max 82 years). HF hosp. (n=65, 14.0%) was found in 8.1% of fasters and 16.4% of non-fasters (HR=0.45, 95% CI=0.24, 0.87;p=0.017). Fasting was retained in multivariable analyses (adjusted HR=0.44, CI=0.23, 0.84;p=0.013). Age, diabetes, prior MI, TIA, and prior HF diagnosis also predicted HF hosp. Qualitative but non-significantly lower risk for fasting vs non-fasters was found for mortality (3.7% vs 5.8%), MI (0% vs 1.2%), and revasc. (1.5% vs 2.7%), but not stroke (1.5% vs 1.5%). Composites were significant HF hosp./mortality, n=74 (10.4% vs 18.2%, adj. HR=0.55, CI=0.30, 0.99;p=0.047) and major adverse cardiovascular events (MACE HF hosp., mortality, MI, revasc., stroke), n=86 (12.6% vs 21.0%, adj. HR=0.58, CI=0.34, 1.00;p=0.0504). Conclusion Routine periodic fasting was associated with a lower risk of HF hosp., HF hosp./mortality, and MACE in patients at high risk due to COVID-19 diagnosis. This supports and expands on previous studies that reported fasting may reduce the risk of incident HF and reduce the risk of severe COVID-19. Further study of fasting and heart failure is indicated. Prevention and Health PromotionCopyright © 2023 American College of Cardiology Foundation