Glycemic index, glycemic load, and cardiovascular disease and mortality

• Main Authors: Alhabib, K.F (Author), Avezum, A. (Author), Bangdiwala, S.I (Author), Chifamba, J. (Author), Dehghan, M. (Author), Díaz, R. (Author), Iqbal, R. (Author), Ismail, N. (Author), Jenkins, D.J.A (Author), Khatib, R. (Author), Lanas, F. (Author), Li, W. (Author), Liu, X. (Author), Lopez-Jaramillo, P. (Author), Mente, A. (Author), Mohammadifard, N. (Author), Mohan, V. (Author), Oguz, A. (Author), Pepe, A. (Author), Poirier, P. (Author), Rangarajan, S. (Author), Rosengren, A. (Author), Srichaikul, K. (Author), Swaminathan, S. (Author), Teo, K. (Author), Yeates, K. (Author), Yusoff, K. (Author), Yusuf, R. (Author), Yusuf, S. (Author), Yusufali, A.H (Author), Zatońska, K. (Author)
• Format: Article
• Language: English
• Published: Massachussetts Medical Society 2021
• Series: New England Journal of Medicine
• Subjects: adult; Adult; adverse event; aged; Aged; Article; body mass; caloric intake; carbohydrate; carbohydrate diet; cardiovascular disease; Cardiovascular Diseases; cardiovascular risk; clinical trial; controlled study; diet; Diet; Diet Surveys; Dietary Carbohydrates; dietary intake; Dietary Sugars; female; Female; follow up; Follow-Up Studies; food composition; food frequency questionnaire; frailty; glycemic index; Glycemic Index; glycemic load; Glycemic Load; Heart Disease Risk Factors; highest income group; human; Humans; lowest income group; major clinical study; male; Male; middle aged; Middle Aged; middle income group; mortality; multicenter study; nutritional status; priority journal; social status; sugar intake; treatment outcome
• Online Access: View Fulltext in Publisher; View in Scopus

 BACKGROUND Most data regarding the association between the glycemic index and cardiovascular disease come from high-income Western populations, with little information from non-Western countries with low or middle incomes. To fill this gap, data are needed from a large, geographically diverse population. METHODS This analysis includes 137,851 participants between the ages of 35 and 70 years living on five continents, with a median follow-up of 9.5 years. We used country-specific food-frequency questionnaires to determine dietary intake and estimated the glycemic index and glycemic load on the basis of the consumption of seven categories of carbohydrate foods. We calculated hazard ratios using multivariable Cox frailty models. The primary outcome was a composite of a major cardiovascular event (cardiovascular death, nonfatal myocardial infarction, stroke, and heart failure) or death from any cause. RESULTS In the study population, 8780 deaths and 8252 major cardiovascular events occurred during the follow-up period. After performing extensive adjustments comparing the lowest and highest glycemic-index quintiles, we found that a diet with a high glycemic index was associated with an increased risk of a major cardiovascular event or death, both among participants with preexisting cardiovascular disease (hazard ratio, 1.51; 95% confidence interval [CI], 1.25 to 1.82) and among those without such disease (hazard ratio, 1.21; 95% CI, 1.11 to 1.34). Among the components of the primary outcome, a high glycemic index was also associated with an increased risk of death from cardiovascular causes. The results with respect to glycemic load were similar to the findings regarding the glycemic index among the participants with cardiovascular disease at baseline, but the association was not significant among those without preexisting cardiovascular disease. CONCLUSIONS In this study, a diet with a high glycemic index was associated with an increased risk of cardiovascular disease and death. Copyright © 2021 Massachusetts Medical Society.