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Diets containing large amounts of carbohydrates with a high glycemic index (“poor-quality carbs”) clearly increase risk for developing type 2 diabetes. However, the effect on cardiovascular risk is less clear and has been evaluated largely in studies conducted in affluent Western nations.
An international team studied 138,000 people (age range, 35–70) in 20 countries, with a wide range of median incomes, located on 5 continents. Participants were followed for a median 9.5 years, during which they reported their food intake on questionnaires adapted to their cultures. The primary outcome was a composite of cardiovascular-related death, nonfatal myocardial infarction, stroke, heart failure, or death from any cause. After multivariable adjustme…