Real-World Cardiovascular Outcomes with a Carbohydrate-Reduced Telemedicine Intervention
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Importance
Carbohydrate-reduced nutrition improves multiple metabolic risk factors, but its influence on long-term cardiovascular (CV) outcomes remains uncertain.
Objective
To evaluate the impact of an individualized telemedicine nutrition therapy on the incidence of CV events.
Design
Claims-based cohort study of adults with type 2 diabetes or obesity receiving telemedicine nutrition therapy versus a propensity score matched control group between January 1, 2016 and June 1, 2025, with a median follow-up of approximately two years.
Setting
The intervention cohort, a US-based nationwide digital health clinic, received individualized telemedicine nutrition and clinical care. The matched control cohort was derived from a commercial claims database.
Participants
Adults with type 2 diabetes or obesity and no CV events one year prior to index date.
Exposure
Individualized nutrition therapy (INT) program combining telemedicine clinical care and carbohydrate-reduced nutrition counseling.
Main Outcomes and Measures
Four prespecified primary outcomes included 1) 3-point major adverse CV events (MACE), defined as nonfatal myocardial infarction, nonfatal stroke, or death from any cause; 2) 6-point MACE, adding percutaneous coronary intervention, hospitalization for heart failure or unstable angina; 3) all new-onset CV events; and 4) new-onset hypertension. Secondary outcomes included all-cause mortality, and safety outcomes related to arrhythmias.
Results
In 4,877 participants in each cohort (mean age, 51 [SD 9.5] years; 2,939 [60.3%] female), INT was associated with reduced risk of all primary outcomes. Incidence per 1,000 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 CV disease, 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 CV disease, and 0.81 (95% CI, 0.70-0.93; P <0.001) for new-onset hypertension.
Conclusions and Relevance
Individualized telemedicine nutrition therapy was associated with lower CV event incidence compared to controls, suggesting the intervention may confer cardioprotection.
KEY POINTS
Question
What is the impact of an individualized telemedicine nutrition program on cardiovascular events?
Findings
In this claims-based cohort study, individuals receiving carbohydrate-reduced nutrition therapy had significantly reduced risk of all primary outcomes compared with matched controls: 56% lower 3-point MACE, 48% lower 6-point MACE, 30% lower risk of all new-onset cardiovascular events, and 19% lower new-onset hypertension. The risk of all-cause mortality was also directionally reduced.
Meaning
Telemedicine nutrition therapy was associated with favorable cardiovascular outcomes compared to usual care.
