Objective To examine the association of long term intake of gluten with the development of incident coronaryheartdisease.
Setting and participants 64 714 women in the Nurses' Health Study and 45 303 men in the Health Professionals Follow-up Study without a history of coronaryheartdisease who completed a 131 item semiquantitative food frequency questionnaire in 1986 that was updated every four years through 2010.
ExposureConsumption of gluten, estimated from food frequency questionnaires.
Main outcome measure Development of coronaryheartdisease (fatal or non-fatal myocardial infarction).
Results During 26 years of follow-up encompassing 2 273 931 person years, 2431 women and 4098 men developed coronaryheartdisease. Compared with participants in the lowest fifth of gluten intake, who had a coronaryheartdisease incidence rate of 352 per 100 000 person years, those in the highest fifth had a rate of 277 events per 100 000 person years, leading to an unadjusted rate difference of 75 (95% confidence interval 51 to 98) fewer cases of coronaryheartdisease per 100 000 person years. After adjustment for known risk factors, participants in the highest fifth of estimated gluten intake had a multivariable hazard ratio for coronaryheartdisease of 0.95 (95% confidence interval 0.88 to 1.02; P for trend=0.29). After additional adjustment for intake of whole grains (leaving the remaining variance of gluten corresponding to refined grains), the multivariate hazard ratio was 1.00 (0.92 to 1.09; P for trend=0.77). In contrast, after additional adjustment for intake of refined grains (leaving the variance of gluten intake correlating with whole grain intake), estimated glutenconsumption was associated with a lower risk of coronaryheartdisease (multivariate hazard ratio 0.85, 0.77 to 0.93; P for trend=0.002).
ConclusionLong term dietary intake of gluten was not associated with risk of coronaryheartdisease. However, the avoidance of gluten may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk. The promotion of gluten-free diets among people without celiacdisease should not be encouraged.
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