Abstract / Summary
Cardiovascular (CV) risk factors improve with carbohydrate-reduced nutrition, but the impact on CV outcomes is unknown. We assessed the incidence of CV outcomes associated with a carbohydrate-reduced telemedicine intervention in a retrospective claims-based cohort study. Adults with type 2 diabetes or obesity receiving individualized nutritional therapy (INT) between January 1, 2016 and June 1, 2025, were compared with propensity score-matched controls. Primary outcomes included (1) 3-point major adverse CV events (MACE), defined as nonfatal myocardial infarction, nonfatal stroke, or death from any cause (MACE−3); (2) 6-point MACE, adding percutaneous coronary intervention, hospitalization for heart failure or unstable angina (MACE−6); (3) all new-onset CV disease (CVD) events; and (4) new-onset hypertension. In 4877 participants in each cohort (mean age, 51 [SD 9.5] years; 2939 [60.3%] female), INT was associated with lower risk of all primary outcomes. Incidence per 1000 person-years was 4.1 vs. 9.3 for MACE-3, 5.7 vs. 10.8 for MACE-6, 27.7 vs. 36.9 for all new-onset CVD, and 41.8 vs. 49.3 for new-onset hypertension. Hazard ratios were 0.44 (95% CI, 0.29–0.65; P < 0.001) for MACE-3, 0.52 (95% CI, 0.37–0.73; P < 0.001) for MACE−6, 0.70 (95% CI, 0.59–0.82; P < 0.001) for all CVD, and 0.81 (95% CI, 0.70–0.93; P < 0.001) for new-onset hypertension. Individualized telemedicine nutrition therapy was associated with lower CV event incidence compared to controls, suggesting the intervention may confer cardioprotection. People with type 2 diabetes or obesity have a higher risk of heart and blood vessel disease. Carbohydrate-reduced nutrition improves blood sugar, body weight, blood pressure, and other cardiovascular health factors. However, researchers do not yet know whether these improvements lead to fewer cardiovascular events, such as heart attacks and strokes. The researchers used medical and prescription insurance claims to compare adults receiving an individualized, carbohydrate-reduced nutrition program through telemedicine with similar adults receiving usual care. Each group included 4877 people. Participants had type 2 diabetes or obesity but no known cardiovascular disease when the study began. The researchers compared rates of heart attack, stroke, death, heart failure, unstable angina, procedures to open blocked arteries, other new cardiovascular conditions, and high blood pressure. People in the telemedicine nutrition program experienced fewer cardiovascular health events than those receiving usual care. The program group had a 56% lower risk of heart attack, stroke, or death and a 48% lower risk when additional serious cardiovascular outcomes were included. They also had a 30% lower risk of developing cardiovascular disease and a 19% lower risk of developing hypertension. These results suggest that individualized, carbohydrate-reduced nutrition delivered through telemedicine may help protect cardiovascular health. Because this was an observational study, it cannot prove that the program caused the lower event rates. Randomized clinical trials and longer-term studies are needed.