BACKGROUND AND PURPOSE:

• Mossavar-Rahman et al. (Stroke, 2019) sought to assess whether there is an association between artificially sweetened beverages (ASB) and risk of stroke, coronary heart disease, and all-cause mortality

METHODS:

• Multicenter longitudinal cohort study
  • Women’s Health Initiative Observational Study (WHI-OS)
  • 100,000 postmenopausal women enrolled (1993-1998)
  • Women were aged 50 to 79 years
  • 11.9 years mean follow up in parent study
• In the current study, participants were asked about their ABS consumption at the 3-year time point
• Outcomes
  • Overall stroke
  • Coronary heart disease (CHD)
  • All-cause mortality
• Exposure
  • Questionnaire that asked about the drinking frequency of unsweetened beverages during the previous 3 months
  • 4 categories: <1 time a week | 1 to 4 times a week | 5 to 7 times a week | ≥2 times a day
• Multivariate analyses to control for confounding

RESULTS:

• 81,714 women were included
  • 64.1% of women were infrequent consumers (never or <1/week) of ASB
  • 5.1% consuming ≥2 ASBs/day
• Those consuming ≥2 ASBs/day (most frequent) compared to <1 ASBs/week (rare or none)
  • Had significantly greater likelihood of all end points (except hemorrhagic stroke)
• Adjusted models demonstrated the following
  • All stroke:  Hazard ratio (HR) 1.23 (95% CI, 1.02–1.47)
  • Ischemic stroke: HR 1.31 (95% CI, 1.06–1.63) 
  • CHD: HR 1.29 (95% CI, 1.11–1.51)
  • All-cause mortality: HR 1.16 (95% CI, 1.07–1.26)
• No prior history of CVD or diabetes
  • High consumption was associated with >2-fold increased risk of small artery occlusion ischemic stroke
  • HR 2.44 (95% CI, 1.47–4.04)
• BMI ≥30
  • No significant interaction between BMI across most of the various frequency categories
  • High consumption (5-7 ASBs/week) was associated with increased risk of ischemic stroke (P=0.05)
    • HR 2.03 (95% CI, 1.38–2.98)

CONCLUSION:

• In postmenopausal women, higher intake of ABS was associated with increased risk for ischemic stroke, CHD, and all-cause mortality
• Authors recognize limitation of study due to observational design and that further studies would be required to guide clinical recommendations

Learn More – Primary Sources:

Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women’s Health Initiative

JAMA: No Compelling Evidence of Health Benefits From Nonsugar Sweeteners

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