Table 2.

Carbohydrate

Macronutrient	Source and quality	Summary
Carbohydrates	Plant Refined and whole grain breads and cereals, pastas, rice, fruits and vegetables, and cakes, biscuits and sugar-sweetened beverages Carbohydrate sources that are based around refined white flour should be reduced/avoided and replaced with better quality sources (such as whole grain cereals and breads, or fruits and vegetables). Education may be required to explain to individuals that carbohydrates are not only found in breads, cereals and pastas but are also present in numerous vegetables and fruits	Sources of carbohydrate are important to the relationship of carbohydrates with cardiovascular health. Data from the PURE study indicated higher carbohydrate intake was associated with increased mortality although the sources and quality of carbohydrate was poor, likely explaining this relationship.14 Additionally, the high percentage energy from carbohydrate likely displaced other beneficial nutrients (protein and fat) from the diet. There appear to be different associations between low-carbohydrate high animal fat and protein diets versus low-carbohydrate high plant fat and protein diets and mortality. A low-carbohydrate diet high in plant fat and protein was not associated with increased mortality, whereas a low-carbohydrate diet high animal fat and protein diet was.15 16 Higher fibre intake is inversely associated with cardiovascular and all-cause mortality post-MI.17 Prospective studies support a role for whole grains in cardiovascular health, with whole grain bread, pasta, cereals and oatmeal associated with reduced all-cause mortality, with similar observations for cardiovascular mortality.11 18 However, randomised controlled trials do not support a role for specifically increasing whole grain consumption to reduce lipids, blood pressure and body mass index.19 We recommend that patients are encouraged to consume good quality sources of carbohydrate, such as vegetables and whole grain cereals that are high in fibre as part of a cardioprotective diet. Reducing dietary carbohydrate may be advantageous to those with altered blood glucose control

MI, myocardial infarction; PURE, Prospective Urban Rural Epidemiology.