Glycemic Index, Glycemic Load, and Cardiovascular Disease and Mortality.

Adult Aged Cardiovascular Diseases / epidemiology Diet / adverse effects Diet Surveys Dietary Carbohydrates / adverse effects Dietary Sugars / adverse effects Female Follow-Up Studies Glycemic Index Glycemic Load Heart Disease Risk Factors Humans Male Middle Aged

Journal

The New England journal of medicine

ISSN: 1533-4406

Titre abrégé: N Engl J Med

Pays: United States

ID NLM: 0255562

Informations de publication

Date de publication:
08 04 2021

Historique:

pubmed: 25 2 2021

medline: 23 4 2021

entrez: 24 2 2021

Statut: ppublish

Résumé

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. 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. 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. In this study, a diet with a high glycemic index was associated with an increased risk of cardiovascular disease and death. (Funded by the Population Health Research Institute and others.).

Sections du résumé

BACKGROUND

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. (Funded by the Population Health Research Institute and others.).

Identifiants

DOI: 10.1056/NEJMoa2007123 PMID: 33626252

pubmed: 33626252

doi: 10.1056/NEJMoa2007123

doi:

Substances chimiques

Dietary Carbohydrates 0

Dietary Sugars 0

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

1312-1322

Investigateurs

S Yusuf (S)

S Rangarajan (S)

K K Teo (KK)

S S Anand (SS)

C K Chow (CK)

M O'Donnell (M)

A Mente (A)

D Leong (D)

A Smyth (A)

P Joseph (P)

M Duong (M)

R D'Souza (R)

M Walli-Attaei (M)

S Islam (S)

W Hu (W)

C Ramasundarahettige (C)

P Sheridan (P)

S Bangdiwala (S)

L Dyal (L)

B Liu (B)

C Tang (C)

X Yang (X)

R Zhao (R)

L Farago (L)

M Zarate (M)

J Godreault (J)

M Haskins (M)

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G Rigitano (G)

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