Glycemic load and coronary heart disease in a Mediterranean population: the EPIC Greek cohort study

Nutr Metab Cardiovasc Dis. 2015 Mar;25(3):336-42. doi: 10.1016/j.numecd.2014.12.002. Epub 2014 Dec 11.


Background and aims: High glycemic load (GL) has been associated with increased coronary heart disease (CHD) risk. We evaluated whether preference of low-GL foods conveys incremental benefits with respect to CHD, especially to people adhering to the traditional Mediterranean diet (MD).

Methods and results: We analyzed data from the Greek European Prospective Investigation into Cancer and Nutrition, including 20,275 participants free of cardiovascular diseases, cancer, or diabetes at baseline and without incident diabetes. Subjects completed a validated, semi-quantitative food frequency questionnaire at enrollment. We calculated a 10-point MD adherence score and the dietary GL, and estimated hazard ratios (HRs) for CHD incidence and mortality through Cox proportional hazard regression. After a median follow-up of 10.4 years, 417 participants developed CHD, and 162 died from the disease. A significant positive association of GL with CHD incidence emerged (HR for the highest versus the lowest tertile = 1.41, 95% confidence interval, CI: 1.05-1.90). HRs for CHD mortality exceeded unity but were not statistically significant. The association with GL was stronger among subjects with higher body mass index. High adherence to MD with low/moderate GL was associated with lower risk of CHD incidence (HR = 0.61, CI: 0.39-0.95) and mortality (HR = 0.47, 95% CI: 0.23-96).

Conclusion: High dietary GL increases the risk of CHD. Compared to a high GL diet with suboptimal adherence to the traditional Mediterranean pattern, a low/moderate GL diet that also conforms to the traditional MD principles could lead to a 40% reduced risk for CHD, and over 50% reduced risk for death from CHD.

Keywords: Cohort study; Coronary heart diseases; Diet; Glycemic load; Mediterranean diet.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Coronary Disease / diet therapy*
  • Coronary Disease / mortality*
  • Diet, Mediterranean
  • Feeding Behavior*
  • Female
  • Follow-Up Studies
  • Glycemic Load*
  • Greece
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Nutritional Status
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Surveys and Questionnaires
  • Whites*
  • Young Adult