Association of periodic fasting lifestyles with survival and incident major adverse cardiovascular events in patients undergoing cardiac catheterization

Abstract

Aims Animal models repeatedly show fasting increases longevity. Human data, though, are limited to anecdotal claims. This study evaluated the association of routine fasting with survival and, secondarily, with incident major adverse cardiovascular events. Methods and results Cardiac catheterization patients enrolled in the Intermountain INSPIRE longitudinal cohort (n = 2785) during 2013–2015 were followed through March 2019. A fasting survey was completed in n = 2025 (73%) of this cohort and 1957 were included in the final data analysis after 68 participants were removed (24 for data issues and 44 for fasting less than 5 years). Self-reported routine fasting behaviour, years of participation in fasting, and other fasting characteristics were surveyed. Mortality was the primary outcome and incident myocardial infarction (MI), stroke, and heart failure (HF) were secondary. Routine fasters (n = 389, mean age 64 ± 14 years, 34% female) averaged 42 ± 18 years of routine fasting (minimum 5 years). Non-fasters (n = 1568, aged 63 ± 14 years, 36% female) included never fasters (n = 1120 with 0 years of fasting) and previous fasters (n = 448 who averaged 32 ± 21 years of prior fasting but had stopped prior to enrolment). Routine fasters had greater survival vs. non-fasters [adjusted hazard ratio (HR) = 0.54, 95% confidence interval (CI) = 0.36–0.80; P = 0.002] and lower incidence of HF (adjusted HR = 0.31, CI = 0.12–0.78; P = 0.013), but not MI or stroke after adjustment. Conclusions Routine fasting followed during two-thirds of the lifespan was associated with higher survival after cardiac catheterization. This may in part be explained by an association of routine fasting with a lower incidence of HF. Clinical study registration The Intermountain INSPIRE registry https://clinicaltrials.gov/, NCT02450006.

Association of Periodic Fasting with Lower Severity of COVID-19 Outcomes in the SARS-CoV-2 Pre-Vaccine Era: An Observational Cohort from the INSPIRE Registry

“…( 15) A trend toward lower MI incidence was also found in that study. (15) Further, periodic fasting was associated with a lower risk of CAD and a lower risk of diabetes in cross-sectional studies. (13,14) In the present study, in addition to the association of periodic fasting with a lower risk of hospitalization or mortality, various factors including many comorbidities were associated with a greater risk of hospitalization or mortality.…”

“…(15) These associations may result from various mechanisms not related to weight loss. (6,15-18) Such risk reductions by fasting of diagnoses that exacerbate the severity of COVID-19 [e.g., diabetes, CAD, and HF (19,20)] may indirectly reduce COVID-19 severity, providing a possible third biological mechanism for fasting-induced protection from severe COVID-19 outcomes.…”

“…whom fasting is often done once per month for about 24 hours (13,15). However, because in prior work ≈40% of LDS Church members reported that they engage in periodic fasting and religious preference did not confound the effect of fasting,(13,15) and because the systematically-shared health-related behaviors like not smoking and not drinking alcohol were measured in this study, religious preference per se was not evaluated here.Data elements for race, ethnicity, income, education, marital status, employment status, physical exercise (e.g., swimming, jogging, aerobics, football, tennis, gym workout), cycling, walking, and alcohol use were also drawn from the INSPIRE survey. Age, sex, body mass index (BMI), smoking (current or past), other cardiac risk factors, and comorbidities were extracted electronically from the INSPIRE database or the electronic health record at the time of COVID-19 diagnosis.…”

“…fasting-improved longitudinal outcomes including greater survival and lower risk of incident HF (15). These associations may result from various mechanisms not related to weight loss.…”

Preferential Metabolic Improvement by Intermittent Fasting in People with Elevated Baseline Red Cell Distribution Width: A Secondary Analysis of the WONDERFUL Randomized Controlled Trial

“…Intermittent fasting is a popular dietary health intervention that results in weight loss of a similar level to caloric restriction, leads to improvement in some cardiometabolic risk factors, and is associated with a lower risk of chronic diseases such as coronary heart disease, heart failure, and type 2 diabetes [1][2][3][4][5][6][7][8][9][10][11]. Intermittent fasting may, however, produce a spectrum of individual health responses and even potential harms for different people depending on their health status and medical history.…”