Low Carb Diet Atrial Fibrillation

Observational Study

. 2019 May 7;8(9):e011955.

doi: 10.1161/JAHA.119.011955.

Low-Carbohydrate Diets and Risk of Incident Atrial Fibrillation: A Prospective Cohort Study

Xiaodong Zhuang^{1 2} , Xiaoyu Lin³ , Xiangbin Zhong^{1 2} , Huimin Zhou^{1 2} , Xiuting Sun^{1 2} , Zhenyu Xiong^{1 2} , Yiquan Huang^{1 2} , Yongqiang Fan^{1 2} , Yue Guo^{1 2} , Zhimin Du^{1 2} , Xinxue Liao^{1 2}

Affiliations

PMID: 31020911
PMCID: PMC6512089
DOI: 10.1161/JAHA.119.011955

Free PMC article

Observational Study

Low-Carbohydrate Diets and Risk of Incident Atrial Fibrillation: A Prospective Cohort Study

Shaozhao Zhang et al. J Am Heart Assoc. 2019 .

Free PMC article

Abstract

Background The influences of low-carbohydrate diets in cardiovascular disease are controversial. Few studies have examined the relationship of carbohydrate intake and risk of incident atrial fibrillation ( AF ). We aimed to evaluate the association between carbohydrate intake and the risk of incident AF in the ARIC (Atherosclerosis Risk in Communities) Study. Methods and Results We included 13 385 participants (age, 54.2±5.8 years; 45.1% men and 74.7% white) who completed a dietary questionnaire at baseline (1987-1989) in the ARIC Study. The primary outcome was incident AF , which was identified by ECG performed during study examinations, hospital discharge codes, and death certificates. We used multivariable Cox hazard regression models to assess the association between carbohydrate intake and incident AF . We further explored the effects of specific food source (animal versus plant based) used to replace carbohydrate intake in the low-carbohydrate intake setting. During a median follow-up of 22.4 years, 1808 cases (13.5%) of AF occurred. The hazard ratio for incident AF associated with a 1- SD (9.4%) increase in carbohydrate intake as a percentage of energy intake was 0.82 (95% CI , 0.72-0.94), after adjustment for traditional AF risk factors and other diets factors. Results were similar when individuals were categorized by carbohydrate intake quartiles (hazard ratio, 0.64; 95% CI , 0.49-0.84; comparing extreme quartiles). No association was found between the type of protein or fat used to replace the carbohydrate and risk of incident AF . Conclusions Low-carbohydrate diets were associated with increased risk of incident AF , regardless of the type of protein or fat used to replace the carbohydrate.

Keywords: atrial fibrillation; diet; epidemiology; risk factor.

Figures

**Figure 1**

Flow diagram of participants in the ARIC (Atherosclerosis Risk in Communities) Study.
AF
indicates atrial fibrillation.

**Figure 2**
Kaplan‐Meier curve of incident atrial fibrillation (AF) by quartiles of carbohydrate intake as a percentage of energy.

**Figure 3**
Adjusted hazard ratios of atrial fibrillation by baseline carbohydrate intake as a percentage of energy. Each hazard ratio was computed with a carbohydrate intake level of 50% as the reference. The hazard ratio was adjusted for age, race, total energy intake, total fat intake as a percentage of energy, animal fat intake as a percentage of energy, total protein intake as a percentage of energy, animal protein intake as a percentage of energy, dietary fiber intake, glycemic index, glycemic load, body mass index, smoking, drinking, education level, sport, physical activity, total cholesterol, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, triglycerides, creatine, uric acid, hypertension, stroke, diabetes mellitus, coronary artery disease, and heart failure. Red solid line represents the hazard ratio of carbohydrate intake across the whole range. Red dotted lines represent the 95% CI. Black dotted lines is the reference line as hazard ratio =1. Histograms represent the frequency distribution of carbohydrate intake as a percentage of energy at baseline.

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References

1. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, Gillum RF, Kim YH, McAnulty JJ, Zheng ZJ, Forouzanfar MH, Naghavi M, Mensah GA, Ezzati M, Murray CJ. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129:837–847. - PMC - PubMed
1. Lloyd‐Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasan RS, D'Agostino RB, Massaro JM, Beiser A, Wolf PA, Benjamin EJ. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004;110:1042–1046. - PubMed
1. Benjamin EJ, Chen PS, Bild DE, Mascette AM, Albert CM, Alonso A, Calkins H, Connolly SJ, Curtis AB, Darbar D, Ellinor PT, Go AS, Goldschlager NF, Heckbert SR, Jalife J, Kerr CR, Levy D, Lloyd‐Jones DM, Massie BM, Nattel S, Olgin JE, Packer DL, Po SS, Tsang TS, Van Wagoner DR, Waldo AL, Wyse DG. Prevention of atrial fibrillation: report from a National Heart, Lung, and Blood Institute Workshop. Circulation. 2009;119:606–618. - PMC - PubMed
1. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WJ, Brehm BJ, Bucher HC. Effects of low‐carbohydrate vs low‐fat diets on weight loss and cardiovascular risk factors: a meta‐analysis of randomized controlled trials. Arch Intern Med. 2006;166:285–293. - PubMed
1. Seidelmann SB, Claggett B, Cheng S, Henglin M, Shah A, Steffen LM, Folsom AR, Rimm EB, Willett WC, Solomon SD. Dietary carbohydrate intake and mortality: a prospective cohort study and meta‐analysis. Lancet Public Health. 2018;3:e419–e428. - PMC - PubMed

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