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CLINICAL RESEARCH: CARDIOVASCULAR RISK

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

A Population-Based Follow-Up Study

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands

Manuscript received November 10, 2006; revised manuscript received February 5, 2007, accepted February 12, 2007.

^_* Reprint requests and correspondence: Dr. Joline W. J. Beulens, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Room STR 6.131, P.O. Box 85500, 3508 GA Utrecht, the Netherlands (Email: J.Beulens{at}umcutrecht.nl).

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; p_trend = 0.03). Similar results were observed for dietary glycemic index with a corresponding HR of 1.33 (95% CI 1.07 to 1.67; p_trend = 0.02). Glycemic load tended to be associated with both CHD (HR 1.44; 95% CI 0.95 to 2.19; p_trend = 0.14) and CVA (HR 1.55; 95% CI 0.81 to 2.97; p_trend = 0.10), but glycemic index only with CHD (HR 1.44; 95% CI 1.10 to 1.89; p_trend = 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; p_trend = 0.04), but not among normal weight women (p_interaction = 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.

Abbreviations and Acronyms   BMI = body mass index   CHD = coronary heart disease   CI = confidence interval   CRP = C-reactive protein   CVA = cerebrovascular accidents   CVD = cardiovascular disease   FFQ = food frequency questionnaire   HDL = high-density lipoprotein   HR = hazard ratio   HRT = hormone replacement therapy   ICD-9-CM = International Classification of Diseases-Ninth Revision-Clinical Modification   LDL = low-density lipoprotein   OC = oral contraceptives

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