Author Topic: Carbohydrates doubles heart disease in women  (Read 1432 times)

Offline Warren Dew

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Carbohydrates doubles heart disease in women
« on: June 14, 2010, 08:14:23 AM »
I thought I'd posted this here already, but I couldn't find it, so I'll post it now.

Quote
High consumption of carbohydrates doubled the risk of developing coronary heart disease in women, according to research published this week in the Archives of Internal Medicine.

Carb intake didn't seem to affect heart disease risk in men, however.
http://blog.nutritiondata.com/heart_health_blog/2010/04/highcarb-diet-hard-on-womens-hearts.html
http://archinte.ama-assn.org/cgi/content/abstract/170/7/640

Edit:  bottom line is that the 25% of women who ate the most carbohydrates had twice the risk of heart disease as the 25% of women who ate the least carbohydrates.  The same was not shown in men.  The 2x effect is much higher than even the fat phobes claim for fats or saturated fats.
« Last Edit: August 16, 2010, 12:05:34 PM by Warren Dew »

Offline ajmesa

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Re: Carbohydrates double heart disease in women
« Reply #1 on: June 14, 2010, 11:22:53 AM »
Thanks for the link. To not be biased on this, here's a part of the abstract you didn't quote.

Quote
Increasing carbohydrate intake from high-GI foods was also significantly associated with greater risk of CHD in women (RR, 1.68; 95% CI, 1.02-2.75), whereas increasing the intake of low-GI carbohydrates was not.

Here's the whole abstract:

Quote
Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort
The EPICOR Study

Sabina Sieri, PhD; Vittorio Krogh, MD, MS; Franco Berrino, MD; Alberto Evangelista, BSc; Claudia Agnoli, PhD; Furio Brighenti, PhD; Nicoletta Pellegrini, PhD; Domenico Palli, MD; Giovanna Masala, MD; Carlotta Sacerdote, MD; Fabrizio Veglia, MD; Rosario Tumino, MD; Graziella Frasca, PhD; Sara Grioni, BSc; Valeria Pala, PhD; Amalia Mattiello, MD; Paolo Chiodini, PhD; Salvatore Panico, MD
Arch Intern Med. 2010;170(7):640-647.

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 with coronary heart disease (CHD) in a large and heterogeneous cohort of Italian men and women originally recruited to the European Prospective Investigation into Cancer and Nutrition study.

Methods  We studied 47 749 volunteers (15 171 men and 32 578 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). Increasing carbohydrate intake from high-GI foods was also significantly associated with greater risk of CHD in women (RR, 1.68; 95% CI, 1.02-2.75), whereas increasing the intake of low-GI carbohydrates was not. Women in the highest GL quartile had a significantly greater risk of CHD than did those in the lowest quartile (RR, 2.24; 95% CI, 1.26-3.98), with no significant association in men (P = .03 for interaction).

Conclusion  In this Italian cohort, high dietary GL and carbohydrate intake from high-GI foods increase the overall risk of CHD in women but not men.
« Last Edit: June 14, 2010, 11:25:56 AM by ajmesa »
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Offline Warren Dew

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Re: Carbohydrates double heart disease in women
« Reply #2 on: June 14, 2010, 02:47:02 PM »
Thanks for the link. To not be biased on this, here's a part of the abstract you didn't quote.

Quote
Increasing carbohydrate intake from high-GI foods was also significantly associated with greater risk of CHD in women (RR, 1.68; 95% CI, 1.02-2.75), whereas increasing the intake of low-GI carbohydrates was not.

The strongest correlation was with all carbohydrates, which is what I highlighted.  If you exclude low GI carbohydrates, the significance goes down; if you exclude high GI carbohydrates, the significance also goes down, below the 95% threshhold.  That all just indicates that the unbiased answer is that total carbohydrates is the important part, and making excuses based on the type of carbohydrate you eat is avoiding the answer.

Offline ajmesa

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Re: Carbohydrates double heart disease in women
« Reply #3 on: June 14, 2010, 03:52:18 PM »

The strongest correlation was with all carbohydrates, which is what I highlighted.  If you exclude low GI carbohydrates, the significance goes down; if you exclude high GI carbohydrates, the significance also goes down, below the 95% threshhold.  That all just indicates that the unbiased answer is that total carbohydrates is the important part, and making excuses based on the type of carbohydrate you eat is avoiding the answer.

I am just pointing out part of what the researches claimed for completeness. If the significance is below the 95% threshold we cannot deduce anything from it, you can only speculate. Lumping all carbohydrates together is like lumping all fats together (vegetable oils along with butter, makes no sense) which doesn't really tell us much.

Why be fast to dismiss studies that lump together processed and unprocessed meats and not dismiss studies that lump together all kinds of carbohydrates. The double standard doesn't help anyone. I would definitely agree that the amount of carbohydrates westerners eat is not good for the heart, but when analyzing this data you cannot have that double standard. Your "answer" is not unbiased.
« Last Edit: June 14, 2010, 03:56:28 PM by ajmesa »
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Offline Warren Dew

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Re: Carbohydrates double heart disease in women
« Reply #4 on: June 14, 2010, 04:13:53 PM »
Why be fast to dismiss studies that lump together processed and unprocessed meats and not dismiss studies that lump together all kinds of carbohydrates.

I go with whatever shows the largest results in both cases.

In the case of meat, the results from processed meats are higher than the results from processed meats lumped in with other meats, so it's the processed meat result that I pay attention to, since it may explain the other results as well.

However, in the case of carbohydrates, the results from high glycemic index carbohydrates are lower than the results from all carbohydrates, so it can't just be the high glycemic index carbohydrates that are bad.  Thus, the important result here is the "all carbohydrates" result.

Offline ajmesa

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Re: Carbohydrates double heart disease in women
« Reply #5 on: June 14, 2010, 05:22:33 PM »
However, in the case of carbohydrates, the results from high glycemic index carbohydrates are lower than the results from all carbohydrates, so it can't just be the high glycemic index carbohydrates that are bad.  Thus, the important result here is the "all carbohydrates" result.
There just isn't a significance for low GI carbs.

Anyways, this is just an epi study. If we believed these kind of studies we would probably be eating a very different diet.
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Offline Warren Dew

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Re: Carbohydrates doubles heart disease in women
« Reply #6 on: February 08, 2011, 10:55:46 AM »
Found a link to the full text:

http://stanfordhospital.org/clinicsmedServices/COE/heart/HeartCenterServices/womenHeartHealth/documents/SexDiffJournalClubArticle24_10.pdf

I wanted the full text primarily because I was interested in the results for men:  was the lack of a statistically significant result just because they only had half as many men as women?  No, it turns out the men are really different.  It isn't that they have P values that are low, but higher than 0.05; the P values are really high, even above 0.95 in somce cases, suggesting that men really are different from women in their reaction to carbohydrates, and there really is no effect for men.

A few other notes on the women's results:  while glycemic index foods had a lower correlation with heart disease than had total carbohydrates, glycemic load - basically the amount of the carbohydrate that makes it into the bloodstream as blood sugar - had a higher correlation.  A hint as to what's going on can be seen in the statistics for starch and sugar.  Starch had a noticeable, although not statistically significant, correlation with heart disease, with a risk factor of 1.4 and P=0.2; sugar had no visible correlation, with a risk factor of 1 and P=0.9.  The biggest source of sugar in the study seems to have been fruit, so I suspect it's the fruit that is pulling down the statistical significance of "low GI carbohydrates", since most of the fructose never becomes blood sugar.  I'd be surprised if the other main sources of low GI carbohydrates - pasta and cakes - were what made low GI carbohydrates less bad.

Offline Kaa

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Re: Carbohydrates doubles heart disease in women
« Reply #7 on: February 10, 2011, 08:05:41 AM »
Men and women are different :-) though specifically in the context of this study the difference probably has to do less with carbohydrate metabolism and more with the empirical fact that the women have much less CHD than men. The study mentions that "Lipoprotein metabolism is about twice as fast in women as men because of the stimulatory effects of estrogen in women and the inhibitory effects of androgen in men".

Other than that, I hope everyone realizes that the 95% statistical significance cutoff is just a convention, an arbitrary threshold. For example, the probabilities of 94% and 96% are very close (and really indistinguishable in high-noise studies) although one we'd call "statistically significant" and the other "statistically insignificant".

Linear measures (e.g. correlation) are also not the only ones around. Look at the data for men, carb consumption by quartiles and the number of CVD cases:

Quartile 1 -- 105 cases
Quartile 2 --  59 cases
Quartile 3 --  75 cases
Quartile 4 --  66 cases

Clearly, a linear model fails here, but that almost doubling of the heart cases between quartiles 1 and 2 seems too big to be pure noise. Maybe there's a threshold effect somewhere there? I wish the data from the study were available so that I could slice it and dice it to my satisfaction... Although, of course, there's huge amount of noise here -- food questionnaires are notoriously unreliable, all their independent variables are correlated with each other, etc. etc. I bet this study was expensive, one might have thought they'd take care to improve its statistical efficiency, so to say.

Kaa


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Re: Carbohydrates doubles heart disease in women
« Reply #7 on: February 10, 2011, 08:05:41 AM »