California Teachers Study shows higher risks of CVD, revascularization, and stroke

In women enrolled in the California Teachers Study, drinking one or more servings per day of a sugar-sweetened beverage (SSB) was associated with cardiovascular disease (CVD), revascularization, and stroke, according to study results presented in the Journal of the American Heart Association. In addition, consumption of fruit drinks and caloric soft drinks was also positively associated with CVD and increased the risk of CVD by 42%.

“Sugar-sweetened beverages (SSBs) account for nearly half of the added sugars in the American diet. Among U.S. adults, the mean adjusted intake of added sugars is high (308 kcal/d or 17% of total energy), making SSBs a substantial contributor of calories in this population. SSBs are manufactured carbonated and noncarbonated beverages containing caloric sweeteners or syrups and include caloric soft drinks (i.e., not sugar-free), fruit drinks, sports and energy drinks, sweetened waters, and tea and coffee beverages with added sugars. Reducing intake of added sugars is currently recommended by the World Health Organization, Dietary Guidelines for Americans, and the American Heart Association, but intake levels for the majority of Americans exceed recommendations and almost 50% of adults report consuming at least 1 SSB per day,” wrote these researchers, led by Lorena S. Pacheco, PhD, MPH, RDN, CPH,

Using data from 106,178 women (mean age: 52.1 years) enrolled in the ongoing California Teachers Study who had been followed since 1995, Pacheco and colleagues assessed—for the first time—the association between total and type of SSB intake and incident CVD end points including myocardial infarction (MI), stroke, and revascularization.

Participants filled out a one-time food frequency questionnaire, from which researchers determined the types of SSBs they consumed as well as the frequency with which they did so.

Pacheco and colleagues defined the incidence of CVD as the first occurrence of MI or stroke, and undergoing a revascularization procedure including coronary artery bypass grafting and percutaneous coronary intervention and/or percutaneous transluminal coronary angioplasty.

Over the 20-year follow-up, 8,848 cases of CVD occurred, as did 2,677 incident cases of MI, 2,889 cases of revascularization, and 5,258 cases of stroke.

SSBs included sweetened bottled waters or teas, fruit drinks, and caloric soft drinks. In all, 4.2% of participants reported that they were daily consumers of SSBs, and 40.9% rarely or never consumed them. Those with the highest SSB consumption tended to be younger, current smokers, past/current users of oral contraceptives, and got an average of 220.1 minutes/week of moderate-to-vigorous physical activity. They also had higher daily intakes of total energy and carbohydrates, lower intakes of protein, fat, fruits and vegetables, the highest obesity rates (17.5%), and hypertension (15%).

Compared with those who rarely or never consumed sugar-sweetened beverages, women who consumed 1 or more servings/day had an 18% higher risk of CVD (HR: 1.18; 95% CI: 1.05-1.32; P-trend=0.019), as well as a 26% higher risk for revascularization (HR: 1.26; 95% CI: 1.04-1.54) and an increased risk for stroke (HR: 1.21; 95% CI: 1.04-1.41).

Even after adjusting for confounding factors, including BMI, total energy intake, and fruit/vegetable intake (as a marker of diet quality), women who consumed 1 or more SSB servings/day had a 19% higher risk of CVD (HR: 1.19; 95% CI: 1.06-1.34; P-trend: 0.016) compared with rare or never consumers.

In breaking SSBs down further, researchers found that those who consumed 1 or more serving/day of fruit drinks had a higher risk of CVD (HR: 1.42; 95% CI: 1.00-2.01; P-trend=0.021) compared with rare or never consumers of fruit drinks. And those who consumed 1 or more serving/day of caloric soft drinks had a 23% higher risk of CVD (HR: 1.23; 95% CI: 1.05-1.44; P-trend=0.0002) compared with those who rarely or never consumed soft drinks.

Pacheco and fellow researchers also found a nonsignificant positive association between CVD risk and sweetened bottled water or tea intake.

Study limitations include a single dietary assessment to evaluate SSB intakes, failure to measure changes in beverage consumption intake over time, and the exclusion of other beverages, including diet soft drinks, diet carbonated beverages, and sweetened hot beverages in the FFQ version used. Another limitation was non-adjustment for cardiometabolic risk factors, including blood pressure, total cholesterol, HDL cholesterol, and triglycerides.

Reducing consumption of sugar-sweetened beverages may be effective in promoting improved cardiovascular health, stressed Pacheco and colleagues.

“Our results expand the literature on unfavorable effects of SSB intake, highlighting the importance of efforts to reduce SSB intake and changes to support healthier beverage consumption,” they concluded.

  1. Women who drank one or more sugar-sweetened beverages per day had an almost 20% increased risk of cardiovascular disease compared with those who did not consume or rarely consumed such beverages.

  2. Consumption of fruit drinks and caloric soft drinks was also positively associated with CVD.

E.C. Meszaros, Contributing Writer, BreakingMED™

Pacheco reported no conflicts of interest.

Research was supported by the National Cancer Institute, the University of California San Diego Moores Cancer Center, and the National Heart, Lung, and Blood Institute.

Cat ID: 8

Topic ID: 74,8,730,8,914,192,94,925