Glycemic index, glycemic load, and cardiovascular disease and mortality

David J.A. Jenkins, Mahshid Dehghan, Andrew Mente, Shrikant I. Bangdiwala, Sumathy Rangarajan, Kristie Srichaikul, Viswanathan Mohan, Alvaro Avezum, Rafael Díaz, Annika Rosengren, Fernando Lanas, Patricio Lopez-Jaramillo, Wei Li, Aytekin Oguz, Rasha Khatib, Paul Poirier, Noushin Mohammadifard, Andrea Pepe, Khalid F. Alhabib, Jephat ChifambaAfzal Hussein Yusufali, Romaina Iqbal, Karen Yeates, Khalid Yusoff, Noorhassim Ismail, Koon Teo, Sumathi Swaminathan, Xiaoyun Liu, Katarzyna Zatońska, Rita Yusuf, Salim Yusuf

Research output: Contribution to journalArticlepeer-review

131 Citations (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.

Original languageEnglish
Pages (from-to)1312-1322
Number of pages11
JournalNew England Journal of Medicine
Issue number14
Publication statusPublished - 8 Apr 2021


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