High Dietary Glycemic Load and Glycemic Index Increase Risk of Cardiovascular Disease Among Middle-Aged Women

High Dietary Glycemic Load and Glycemic Index Increase Risk of
Cardiovascular Disease Among Middle-Aged Women

A Population-Based Follow-Up Study

Journal of the American College of Cardiology, article in press

Joline W.J. Beulens PhD, a, , Leonie M. de Bruijne MSca, Ronald P.
Stolk MD, PhDa, Petra H.M. Peeters MD, PhDa, Michiel L. Bots MD, PhDa,
Diederick E. Grobbee MD, PhDa and Yvonne T. van der Schouw PhDa
aJulius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, the Netherlands
Received 10 November 2006; revised 5 February 2007; accepted 12
February 2007. Available online 18 June 2007.

Objectives

The goal of this work was to assess whether high dietary glycemic load
and glycemic index are associated with an increased risk of
cardiovascular disease (CVD).

Background

The associations of dietary glycemic index and glycemic load with risk
of CVD are not well established, particularly in populations consuming
modest glycemic load diets. Moreover, risk may differ between lean and
overweight subjects.

Methods

Associations of glycemic index and glycemic load with incident CVD
were examined in a prospective cohort of 15,714 Dutch women age 49 to
70 years without diabetes or CVD. Dietary glycemic index and glycemic
load were calculated using the glycemic index, carbohydrate content,
and frequency of intake of individual foods.

Results

During 9 ± 2 years of follow-up, 556 cases of coronary heart disease
(CHD) and 243 cases of cerebrovascular accident (CVA) occurred.
Dietary glycemic load (mean = 100; SD = 17) was associated with
increased risk of CVD, adjusted for CVD risk factors and dietary
variables, with a hazard ratio (HR) for the highest against lowest
quartile of 1.47 (95% confidence interval [CI] 1.04 to 2.09; ptrend =
0.03). Similar results were observed for dietary glycemic index with a
corresponding HR of 1.33 (95% CI 1.07 to 1.67; ptrend = 0.02).
Glycemic load tended to be associated with both CHD (HR 1.44; 95% CI
0.95 to 2.19; ptrend = 0.14) and CVA (HR 1.55; 95% CI 0.81 to 2.97;
ptrend = 0.10), but glycemic index only with CHD (HR 1.44; 95% CI 1.10
to 1.89; ptrend = 0.01). Among overweight women (body mass index >25
kg/m2), glycemic load was associated with CVD (1.78; 95% CI 1.11 to
2.85; ptrend = 0.04), but not among normal weight women (pinteraction
= 0.19). Body mass index did not modify the association of glycemic
index with CVD.

Conclusions

Among women consuming modest glycemic load diets, high dietary
glycemic load and glycemic index increase the risk of CVD,
particularly for overweight women.

This study shows that high intakes of dietary glycemic load and
glycemic index increase risk of cardiovascular disease among middle-
aged women consuming modest glycemic load diets. These harmful effects
may particularly affect overweight women. Recommendations of a high-
carbohydrate diet may therefore not be optimal in the prevention of
cardiovascular diseases.

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Marilyn

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