Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort

Background: Dietary glycemic load (GL) and glycemic index (GI) in relation to cardiovascular disease have been investigated in a few prospective studies with inconsistent results, particularly in men. The present EPICOR study investigated the association of GI and GL withcoronaryheartdisease(CHD)inalargeandheterogeneous cohort of Italian men and women originally recruited to the European Prospective Investigation into Cancer and Nutrition study. Methods: We studied 47749 volunteers (15171 men and 32578 women) who completed a dietary questionnaire. Multivariate Cox proportional hazards modeling estimated adjusted relative risks (RRs) of CHD and 95% confidence intervals (CIs). Results:During a median of 7.9 years of follow-up, 463 CHD cases (158 women and 305 men) were identified. Women in the highest carbohydrate intake quartile had a significantly greater risk of CHD than did those in the lowest quartile (RR, 2.00; 95% CI,1.16-3.43), with no association found in men (P=.04 for interaction). Increasingcarbohydrateintakefromhigh-GIfoodswasalso significantlyassociatedwithgreaterriskofCHDinwomen (RR, 1.68; 95% CI, 1.02-2.75), whereas increasing the intake of low-GI carbohydrates was not. Women in the highestGLquartilehadasignificantlygreaterriskofCHD than did those in the lowest quartile (RR, 2.24; 95% CI, 1.26-3.98),withnosignificantassociationinmen(P=.03 for interaction). Conclusion: In this Italian cohort, high dietary GL and carbohydrateintakefromhigh-GIfoodsincreasetheoverall risk of CHD in women but not men.