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Cardiac risk factors and prevention
Original research
Association of carbohydrate and saturated fat intake with cardiovascular disease and mortality in Australian women
  1. Sarah Gribbin1,
  2. Joanne Enticott2,
  3. Allison M Hodge3,4,
  4. Lisa Moran2,
  5. Eleanor Thong5,
  6. Anju Joham2,5,
  7. Sarah Zaman6,7
  1. 1 Monash Cardiovascular Research Centre, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
  2. 2 Monash Centre for Health Research and Implementation, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
  3. 3 Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
  4. 4 Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
  5. 5 Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
  6. 6 Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
  7. 7 Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
  1. Correspondence to Dr Sarah Zaman, Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia; sarah.zaman{at}sydney.edu.au

Abstract

Background Conflicting evidence surrounds the effect of dietary macronutrient intake (fat, carbohydrate and protein) on cardiovascular disease (CVD), particularly in women.

Methods Women (aged 50–55 years) were recruited into the Australian Longitudinal Study on Women’s Health. Women were divided into quintiles according to their carbohydrate and saturated fat intake as a percentage of total energy intake (TEI). The primary endpoint was new-onset CVD (heart disease/stroke). Secondary endpoints included all-cause mortality, incident hypertension, obesity and/or diabetes mellitus. Multivariate logistic regression models assessed for associations with the primary and secondary endpoints, with adjustment for confounders.

Results A total of 9899 women (mean age 52.5±1.5 years) were followed for 15 years, with 1199 incident CVD and 470 deaths. On multivariable analysis, higher carbohydrate intake was associated with lower CVD risk (ptrend<0.01), with the lowest CVD risk for quintile 3 (41.0%–44.3% energy as carbohydrate) versus quintile 1 (<37.1% energy as carbohydrate) (OR 0.56, 95% CI 0.35 to 0.91, p=0.02). There was no significant association between carbohydrate intake and mortality (ptrend=0.69) or between saturated fat intake and CVD (ptrend=0.29) or mortality (ptrend=0.25). Both increasing saturated fat and carbohydrate intake were significantly inversely associated with hypertension, diabetes mellitus and obesity (ptrend<0.01 for all).

Conclusions In middle-aged Australian women, moderate carbohydrate intake (41.0%–44.3% of TEI) was associated with the lowest risk of CVD, without an effect on total mortality. Increasing saturated fat intake was not associated with CVD or mortality and instead correlated with lower rates of diabetes, hypertension and obesity.

  • coronary artery disease
  • stroke
  • hypertension
  • obesity
  • diabetes mellitus

Data availability statement

Data may be obtained from a third party and are not publicly available. The data from the Australian Longitudinal Study on Women's Health used in this analysis can be requested from the Data Access Committee of the University of Queensland (https://www.alswh.org.au/for-data-users/applying-for-data/).

https://doi.org/10.1136/heartjnl-2021-319654

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The data from the Australian Longitudinal Study on Women's Health used in this analysis can be requested from the Data Access Committee of the University of Queensland (https://www.alswh.org.au/for-data-users/applying-for-data/).

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    Footnotes

    • Contributors SG was responsible for conducting the literature review, assisting in data analysis and writing the manuscript. JE performed the data analysis and critically reviewed the manuscript. AJ, ET, LM and AMH critically reviewed the manuscript. SZ is responsible for the conception of the study, study design, critically reviewing the manuscript and for the overall content as the guarantor.

    • Funding SZ and LM are supported by National Heart Foundation Fellowships.

    • Competing interests SZ has obtained research funding from Abbott Vascular and Biotronik Australia and speaking honoraria or consulting fees from AstraZeneca, Amgen and Medtronic Australia.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.