Poor-Quality Carbohydrates Linked to Cardiovascular Risk and Mortality, Around the World

Cardiovascular disease (CVD) has been associated with intake of poor-quality carbohydrates, defined as those containing low amounts of fiber, high amounts of refined grains, and high glycemic index (a measure of how much a given carbohydrate raises blood glucose levels). Most of these data have come from high-income, Western populations. These authors examined data on 137,851 participants (age range, 35–70) in the PURE study to determine whether the association holds worldwide, including in non-Western, low- and middle-income countries.

The low-income countries were Bangladesh, India, Pakistan, Tanzania, and Zimbabwe. Using participants' country-specific food-frequency questionnaires, investigators estimated carbohydrate intake and glycemic index.

At a median 9.5-year follow-up, diets with a high glycemic index were associated with the primary composite outcome (total mortality, CV death, nonfatal myocardial infarction, nonfatal stroke, and heart failure) in patients without baseline CVD and in those with baseline CVD (hazard ratios, 1.21 and 1.51, respectively). The association between glycemic index and CV risk or death was greater for individuals with body-mass index ≥25.