Association between the Dietary Approaches to Stop Hypertension (DASH) diet and risk of incident heart failure and heart failure-related death: a UK Biobank cohort study

Lee Patricia Liao; Patroys De Paz; Simone Marschner; Gary C H Gan; Liza Thomas; Luigi Fontana; Sarah Zaman

doi:10.1136/openhrt-2026-004101

July 1, 2026Open HeartOpen Access

Association between the Dietary Approaches to Stop Hypertension (DASH) diet and risk of incident heart failure and heart failure-related death: a UK Biobank cohort study

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Why the study?

Evidence supporting dietary interventions for HF prevention remains limited, and population-level evidence linking DASH adherence to HF risk is sparse.

Does high adherence to the DASH diet reduce the risk of incident heart failure and heart failure-related death in adults free of heart failure at baseline?

Structured PICO

Does high adherence to the DASH diet reduce the risk of incident heart failure and heart failure-related death in adults free of heart failure at baseline?

P

Population

124,777 UK Biobank participants free of HF at baseline (2006-2010), mean age 56.1±7.8 years, 56% female, 7% with diabetes, 36% with hypertension.

I

Intervention

Highest quintile of adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (assessed using ≥2 instances of 24-hour recall)

C

Comparator

Lowest quintile of adherence to the DASH diet

O

Outcome

Composite outcome of incident HF or HF-related deathcomposite

Greater adherence to the DASH diet is associated with a significantly lower risk of incident heart failure, heart failure-related death, hypertension, and type 2 diabetes.

Implication

Supports DASH counseling for HF risk reduction now; extends prior observational data but leaves open causality.

Abstract

BACKGROUND: Evidence supporting dietary interventions for heart failure (HF) prevention remains limited. The Dietary Approaches to Stop Hypertension (DASH) diet has been proposed as a cardioprotective dietary pattern, but population-level evidence linking DASH adherence to HF risk is sparse. AIM: To examine the association between adherence to the DASH diet-characterised by high intake of vegetables, fruits and whole grains, and lower consumption of sodium and red and processed meat-with combined risk of HF incidence and death due to HF, as well as its risk factors, namely hypertension and type 2 diabetes mellitus (T2DM). METHODS: A prospective cohort analysis was conducted using UK Biobank participants free of HF at baseline (2006-2010), with follow-up to 2024. Dietary intake was assessed using ≥2 instances of 24-hour recall. DASH scores were derived and categorised into quintiles. Fine-Gray competing risks Cox models estimated adjusted HRs (aHRs) and 95% CIs for a primary composite outcome of incident HF or HF-related death, adjusting for sociodemographic factors, deprivation, obesity, smoking, hypertension and T2DM and accounting for all-cause mortality. Secondary outcomes were incident hypertension and T2DM. RESULTS: Among 124 777 participants (mean age 56.1±7.8 years; 56% female; 7% with diabetes; 36% with hypertension), followed for a mean of 12 years, 2931 HF events and 441 HF-related deaths occurred. Compared with the lowest DASH adherence quintile, the highest quintile had a lower risk of HF after adjustment for sociodemographic factors (aHR 0.79, 95% CI 0.70 to 0.89, p<0.001) and comorbidities (aHR 0.89, 95% CI 0.79 to 1.00, p<0.05). Greater DASH adherence was associated with reduced risk of hypertension (aHR 0.91, 95% CI 0.86 to 0.96, p<0.001) and T2DM (aHR 0.82, 95% CI 0.75 to 0.90, p<0.001). CONCLUSIONS: Greater adherence to the DASH diet was associated with lower combined risk of HF and death due to HF, as well as hypertension and T2DM, supporting the role of a DASH diet in HF prevention.