Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Epidemiology and Biostatistics Department, Health School, Isfahan University of Medical Sciences, Isfahan, Iran.
Crit Rev Food Sci Nutr. 2022;62(23):6277-6292. doi: 10.1080/10408398.2021.1900057. Epub 2021 Mar 19.
Previous findings on the association of dietary carbohydrate with cardiovascular disease (CVD) events and mortality are inconsistent. We aimed to assess the relationship between dietary carbohydrate and the incidence of cardiovascular events and mortality. A comprehensive literature search of MEDLINE (PubMed), Scopus, ISI Web of Science, and EMBASE, was performed up to June 2019. Prospective cohort studies which examined dietary carbohydrate in relation to fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, heart failure, and sudden cardiac death were included in our study. Summary HRs and 95% CIs were estimated using a random-effects model. A total of 19 cohort studies including 15,663,111 participants were identified. Combining 27 effect sizes with 1,577,225 CVD cases led to a significant association between dietary carbohydrate and total CVD events (HR= 1.05, 95% CI: 1.00, 1.10; I = 38.5%), but no association was observed between dietary carbohydrate and CVD mortality (HR = 1.02; 95% CI: 0.91, 1.14; I=27.1%, derived from 8 effect sizes with 106,412 events), and CHD events (HR = 1.03, 95% CI: 0.98, 1.09; I = 46.6%, derived from 18 effect sizes with 1,549,281 events). Moreover, using 8 effect sizes with 6,829 cases, higher carbohydrate intake was associated with increased risk of stroke (HR = 1.13; 95% CI: 1.01, 1.27; I= 0.0%). In subgroup analysis by sex, higher carbohydrate intake increased the risk of total CVD events (HR: 1.10; 95% CI: 1.03, 1.17; I = 0.0%), and CHD (HR: 1.10; 95% CI: 1.01, 1.20; I= 15.0%), but not stroke and CVD mortality in women. No significant association was found in men. Low- to very-low-certainty evidence suggests that higher carbohydrate intake is directly but slightly associated with CVD and stroke risk, while no association was found for CHD and CVD mortality. We also found sex-specific associations.
先前关于饮食碳水化合物与心血管疾病（CVD）事件和死亡率之间关联的研究结果并不一致。我们旨在评估饮食碳水化合物与心血管事件和死亡率发生之间的关系。对 MEDLINE（PubMed）、Scopus、ISI Web of Science 和 EMBASE 进行了全面的文献检索，检索截至 2019 年 6 月。本研究纳入了前瞻性队列研究，这些研究检查了饮食碳水化合物与致命和非致命性心肌梗死、致命和非致命性中风、心力衰竭和心源性猝死之间的关系。使用随机效应模型估计汇总 HR 和 95%CI。共纳入 19 项队列研究，包括 15663111 名参与者。将 27 个效应量与 1577225 例 CVD 病例相结合，表明饮食碳水化合物与总 CVD 事件之间存在显著关联（HR=1.05，95%CI：1.00，1.10；I=38.5%），但饮食碳水化合物与 CVD 死亡率之间无关联（HR=1.02；95%CI：0.91，1.14；I=27.1%，源自 8 项研究的 106412 例事件），与冠心病事件也无关联（HR=1.03，95%CI：0.98，1.09；I=46.6%，源自 18 项研究的 1549281 例事件）。此外，使用 6829 例事件的 8 个效应量，较高的碳水化合物摄入量与中风风险增加相关（HR=1.13；95%CI：1.01，1.27；I=0.0%）。按性别进行亚组分析，较高的碳水化合物摄入量增加了总 CVD 事件（HR：1.10；95%CI：1.03，1.17；I=0.0%）和冠心病（HR：1.10；95%CI：1.01，1.20；I=15.0%）的风险，但女性中风和 CVD 死亡率没有增加。男性则没有显著相关性。低到非常低确定性证据表明，较高的碳水化合物摄入量与 CVD 和中风风险呈直接但略有相关，而与冠心病和 CVD 死亡率无关。我们还发现了性别特异性关联。
