TY - JOUR
T1 - Glycemic index, glycemic load, and cardiovascular disease and mortality
AU - Jenkins, David J.A.
AU - Dehghan, Mahshid
AU - Mente, Andrew
AU - Bangdiwala, Shrikant I.
AU - Rangarajan, Sumathy
AU - Srichaikul, Kristie
AU - Mohan, Viswanathan
AU - Avezum, Alvaro
AU - Díaz, Rafael
AU - Rosengren, Annika
AU - Lanas, Fernando
AU - Lopez-Jaramillo, Patricio
AU - Li, Wei
AU - Oguz, Aytekin
AU - Khatib, Rasha
AU - Poirier, Paul
AU - Mohammadifard, Noushin
AU - Pepe, Andrea
AU - Alhabib, Khalid F.
AU - Chifamba, Jephat
AU - Yusufali, Afzal Hussein
AU - Iqbal, Romaina
AU - Yeates, Karen
AU - Yusoff, Khalid
AU - Ismail, Noorhassim
AU - Teo, Koon
AU - Swaminathan, Sumathi
AU - Liu, Xiaoyun
AU - Zatońska, Katarzyna
AU - Yusuf, Rita
AU - Yusuf, Salim
N1 - Publisher Copyright:
Copyright © 2021 Massachusetts Medical Society.
PY - 2021/4/8
Y1 - 2021/4/8
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85103737739&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa2007123
DO - 10.1056/NEJMoa2007123
M3 - Article
C2 - 33626252
AN - SCOPUS:85103737739
SN - 0028-4793
VL - 384
SP - 1312
EP - 1322
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 14
ER -
