One Sugar-Sweetened Beverage Per Day Could Negatively Impact Heart Health
MAY 13, 2020
Cheryl Anderson, PhD, MPH
Results of the analysis, which included 20 years of follow-up and more than 100,000 patients, suggest consuming 1 or more sugar-sweetened beverages daily was associated with a 19% increase in risk for cardiovascular disease and a 21% increase in risk of stroke.
“Although the study is observational and does not prove cause and effect, we hypothesize that sugar may increase the risk of cardiovascular diseases in several ways. It raises glucose levels and insulin concentrations in the blood, which may increase appetite and lead to obesity, a major risk factor for cardiovascular disease,” said lead investigator Cheryl Anderson, PhD, MPH, MS, professor and interim chair of Family and Public Health at UCSD and chair of the American Heart Association’s Nutrition Committee, in a statement from the American Heart Association.
Using data from the California Teachers Study (CTS), Anderson and a team of colleagues sought to determine how higher levels of sugar-sweetened beverages on cardiovascular health in women. Of note, CTS is an ongoing cohort study that includes 133,477 active and retired female educators enrolled between 1995-1996.
For inclusion in the analysis, CTS participants needed data related to a 103-item food frequency questionnaire (FFQ) given at baseline that assessed serving size and consumption of various food and beverage items, including multiple meeting the investigators' definition of a sugar-sweetened beverage. Items in the FFQ considered sugar-sweetened beverages were “caloric soft drinks,” “sweetened bottled waters or teas,” and “fruit drinks”.
Investigators followed participants from baseline until diagnosis of a cardiovascular disease event, death, the participant moved out of California, or end of the follow-up period, which was December 31, 2015. For the purpose of the analysis, cardiovascular disease event was defined as first occurrence of fatal or nonfatal myocardial infarction, revascularization procedure, or fatal or nonfatal stroke.
Other exclusion criteria highlighted by investigators included having extremely high or low caloric intake levels and having a history of cardiovascular disease and diabetes before baseline.
Using the aforementioned criteria, investigators identified a cohort of 106,178 female subjects followed for 1,807,182 person-years to first CVD event. FFQ results indicated 4.2% of this cohort were daily consumers of sugar-sweetened beverages compared to the 40.9% who reported rarely or never consuming sugar-sweetened beverages.
During the 20-year follow-up period, investigators observed 8848 incident cases of cardiovascular diseases—including 2677 cases of incident myocardial infarction, 5258 incident stroke cases, 2889 incident cases of revascularization.
After adjusting for potential risk factors and confounders, results of the analysis suggested women who reported consuming sugar-sweetened beverages daily had a 19% (HR, 1.19; 95% CI, 1.06–1.34; P=.016) greater risk of sugar-sweetened beverages than women who rarely or never consumed them. In regard to specific events, risk of revascularization was increased 26% (HR, 1.26; 95% CI, 1.04-1.54), and risk of stroke was increased 21% (HR, 1.21; 95% CI, 1.04-1.41) among women consuming 1 or more sugar-sweetened beverages per day.
Additionally, investigators observed women consuming 1 or more fruit drinks were at a 42% increased risk (HR, 1.42; 95% CI, 1.00-2.01; P-trend=.021) of cardiovascular disease while consuming 1 or more caloric soft drinks was linked to a 23% increase in risk (HR, 1.23; 95% CI, 1.05-1.44; P-trend=.0002]), of cardiovascular disease compared to those who never or rarely consumed these drinks.
This study, “Sugar-Sweetened Beverage Intake and Cardiovascular Disease Risk in the California Teachers Study,” was published in the Journal of the American Heart Association.