Association between Low-carbohydrate Diets and 10-year Atherosclerosis Cardiovascular Disease Risk: Data from the...

To evaluate the association between low-carbohydrate diet (LCD) score and atherosclerotic cardiovascular disease (ASCVD) among individuals with type 2 diabetes mellitus (T2DM).

A total of 3685 participants from the National Health and Nutrition Examination Survey database 2007-2020 were included in this cross-sectional study. The primary outcome of this study was the 10-year ASCVD risk. We used the weighted logistic regression models to assess the association between LCD score and 10-year ASCVD risk. Stratified analysis based on age, body mass index (BMI), hypertension, dyslipidemia, and chronic kidney disease (CKD) was conducted. Odds ratio (OR) and 95% confidence interval (CI) were calculated.

After adjusting for all confounding factors, when LCD was treated as a continuous variable, the findings revealed an inverse association between LCD and 10-year ASCVD risk among individuals with T2DM (OR=0.97, 95% CI: 0.94-0.99, p=0.045). When LCD was stratified into tertiles, individuals in the highest tertiles of LCD exhibited a negative association with 10-year ASCVD risk compared to those in the first tertile (OR=0.66, 95% CI: 0.46-0.95, p=0.025). Subgroup analysis indicated an negative association between high tertiles of LCD and 10-years ASCVD risk in individuals with T2DM who had a BMI≥25kg/m2 (OR=0.66, 95% CI: 0.45-0.97, p<0.05), hypertension (OR=0.61, 95% CI: 0.40-0.91, p<0.05) and dyslipidemia (OR=0.64, 95% CI: 0.43-0.95, p<0.05), and BMI<25kg/m2 with history of CKD (OR=0.64, 95% CI: 0.42-0.96, p<0.05).

The inverse association observed between LCD score and ASCVD risk in individuals with T2DM may be partly explained by improved glycemic control, reduced insulin resistance, and favorable lipid profile changes often associated with lower carbohydrate intake. Notably, the protective effect was more pronounced in individuals with additional metabolic comorbidities, such as obesity, hypertension, and dyslipidemia, suggesting that these subgroups may derive greater cardiovascular benefit from LCD-style eating patterns. However, the cross-sectional nature of our study precludes causal inference. Additionally, dietary intake was self-reported and subject to recall bias, and residual confounding cannot be fully ruled out. Despite these limitations, our findings contribute to the growing body of evidence supporting dietary carbohydrate modification as a potential strategy in cardiovascular risk management among patients with T2DM.

Our study found an inverse association between LCD score and 10-year ASCVD risk in individuals with T2DM. These findings may provide a reference for future research and inform dietary recommendations, though causal relationships cannot be established due to the cross-sectional design.