Association of dietary antioxidant patterns with heart failure risk in patients with hypertension

Hypertension is a major modifiable risk factor for heart failure (HF) and contributes substantially to the cardiovascular disease burden in China. Oxidative stress and redox imbalance have been implicated in the progression from hypertension to HF. The composite dietary antioxidant index (CDAI) has been associated with favorable cardiovascular outcomes; however, evidence regarding its association, particularly the potential nonlinear dose–response relationship, with HF among patients with hypertension remains limited. To investigate the association between CDAI and HF among patients with hypertension and to characterize the dose–response relationship and the relative contributions of the individual antioxidant nutrients included in the CDAI. A total of 1,156 patients with hypertension were included in this study and classified into the HF group ( n = 48) or non-HF group ( n = 1,108) based on the occurrence of HF. Dietary intake was assessed using a validated food-frequency questionnaire, and the CDAI was calculated from seven antioxidant nutrients. Associations between CDAI and HF were evaluated using Firth penalized logistic regression and restricted cubic spline (RCS) analyses. Weighted quantile sum (WQS) regression was used to assess the joint association of the antioxidant nutrient mixture with HF and to estimate the relative contribution of each nutrient. Higher CDAI levels were associated with lower odds of HF. In the fully adjusted Firth penalized logistic regression model, compared with participants in the lowest CDAI tertile, the odds ratios were 0.39 (95% CI, 0.17–0.82; P = 0.013) for the second tertile and 0.21 (95% CI, 0.08–0.54; P < 0.001) for the highest tertile. RCS analysis indicated a significant nonlinear inverse association between CDAI and HF. WQS regression showed that the combined antioxidant nutrient mixture was inversely associated with HF, with total carotenoids and zinc contributing the greatest weights to the mixture index. Higher CDAI levels were associated with lower odds of HF among patients with hypertension, with evidence of a nonlinear dose–response relationship. The combined intake of the seven antioxidant nutrients was also inversely associated with HF, with total carotenoids and zinc making the largest relative contributions. Optimizing dietary antioxidant intake may represent a potential strategy associated with lower HF risk among individuals with hypertension.