title: Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index.
abstract: BACKGROUND
  Studies have suggested that replacing saturated fatty acids (SFAs) with carbohydrates is modestly associated with a higher risk of ischemic heart disease, whereas replacing SFAs with polyunsaturated fatty acids is associated with a lower risk of ischemic heart disease. The effect of carbohydrates, however, may depend on the type consumed.
  
  
  OBJECTIVE
  By using substitution models, we aimed to investigate the risk of myocardial infarction (MI) associated with a higher energy intake from carbohydrates and a concomitant lower energy intake from SFAs. Carbohydrates with different glycemic index (GI) values were also investigated.
  
  
  METHODS
  Our prospective cohort study included 53,644 women and men free of MI at baseline.
  
  
  RESULTS
  During a median of 12 y of follow-up, 1943 incident MI cases occurred. There was a nonsignificant inverse association between substitution of carbohydrates with low-GI values for SFAs and risk of MI [hazard ratio (HR) for MI per 5% increment of energy intake from carbohydrates: 0.88; 95% CI: 0.72, 1.07). In contrast, there was a statistically significant positive association between substitution of carbohydrates with high-GI values for SFAs and risk of MI (HR: 1.33; 95% CI: 1.08, 1.64). There was no association for carbohydrates with medium-GI values (HR: 0.98; 95% CI: 0.80, 1.21). No effect modification by sex was observed.
  
  
  CONCLUSIONS
  This study suggests that replacing SFAs with carbohydrates with low-GI values is associated with a lower risk of MI, whereas replacing SFAs with carbohydrates with high-GI values is associated with a higher risk of MI.
authors.affiliation: Department of Clinical Epidemiology Aarhus University Hospital, Aalborg, Denmark. muj@dce.au.dk <muj@dce.au.dk>
authors.forename: Marianne U
authors.initials: MU
authors.lastname: Jakobsen
authors.forename: Claus
authors.initials: C
authors.lastname: Dethlefsen
authors.forename: Albert M
authors.initials: AM
authors.lastname: Joensen
authors.forename: Jakob
authors.initials: J
authors.lastname: Stegger
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.forename: Erik B
authors.initials: EB
authors.lastname: Schmidt
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
mesh_terms: D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004041:Dietary Fats / Q000008:administration & dosage*; D002149:Energy Intake / Q000502:physiology; D005260:Female; D038321:Glycemic Index / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats