Association of Glycemic Index and Glycemic Load With Risk of Incident Coronary Heart Disease Among Whites and African Americans With and Without Type 2 Diabetes: The Atherosclerosis Risk in Communities Study

Purpose

In this study we examined whether high glycemic index (GI) and glycemic load (GL) diets are associated with increased risk of developing coronary heart disease (CHD) in Whites and African Americans with and without type 2 diabetes.

Methods

Data on 13,051 patients ages 45 to 64 years from the Atherosclerosis Risk in Communities study were analyzed. The ARIC food frequency questionnaire baseline data provided GI and GL indices. A propensity score was created to estimate the effect of a patient's covariates on energy-adjusted GI or GL. During a maximum of 17 years of follow-up, 1683 cases of CHD (371 with diabetes and 1312 without diabetes) were recorded.

Results

For every 5-units increase in GI, there was a 1.16-fold (95% confidence interval [95% CI], 1.01−1.33) increased risk of incident CHD in African Americans. For every 30-units increase in GL, there was a 1.11-fold (95% CI, 1.01−1.21) increased risk of incident CHD in Whites. High GL was an especially important CHD risk factor for Whites without diabetes (per 30-units increase; hazard ratio, 1.14; 95% CI, 1.02−1.26). However, these relationships were not seen in individuals with diabetes.

Conclusions

Nutritional advice to reduce the GI and GL in diets of African Americans and Whites subjects (without diabetes) may play a role in reducing CHD risk.

Key Words: African Americans, Coronary Heart Disease, Glycemic Index, Glycemic Load, Race, Type 2 Diabetes, Whites

Selected Abbreviations and Acronyms: CHD, coronary heart disease, GI, glycemic index, GL, glycemic load, ARIC, Atherosclerosis Risk in Communities, BMI, body mass index, FFQ, food frequency questionnaire, IQR, interquartile range, 95% CI, 95% confidence interval