Soft drinks and sweetened beverages and the risk of cardiovascular disease and mortality: a systematic review and meta-analysis

Abstract

of users lack awareness of their own risk factors. The Heart Age tool was accessed by a group not easily reached by conventional approaches yet is at high cardiovascular risk and would benefit most from early and sustained risk reduction. These are both important opportunities for interventions to educate and empower the public to manage better their cardi-ovascular risk and promote population level prevention. Introduction Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality globally. The importance of primary prevention (PP) of CVD is now well recognised and can potentially improve quality of life and survival cost-effectively. Aim To assess benefits of contemporary guideline based PP recommendations for CVD risk reduction in those with elevated global cardiovascular risk. Methods 402 participants aged 40-74 years were recruited as part of the HAPPY London study. Eligible participants had an elevated 10-year risk based on a QRISK2 score of 10% or more. Internet access was required to be able to register and complete questionnaires online. Individualised one-off cardio-vascular risk reduction advice was provided, based on the JBS3 and ESC 2012 CVD prevention guidelines. Follow-up at 3 months assessed changes in risk factors and risk scores using paired t-test statistical analysis. Results Mean age 65 years; 37% females and 370 (92%) completed the 3-months follow up. There was a small but significant improvement in mean blood pressure from 132/80 mmHg to 129/78 mmHg (p < 0.001). Other improvements included weight, waist circumference, fasting glucose, total cholesterol, physical activity, Framingham and QRISK2 scores (Table 1). QRISK2 score dropped from 18.9% to 18.5% at follow-up. This was a 0.7% absolute reduction compared to expected resulting in about 660 less CVD events per 100,000 over 10 years. Conclusions Implementing guideline recommendation for CVD PP can produce modest improvements in risk factors in the medium term in patients at high cardiovascular risk. Promoting long-term compliance should help lower future cardiovas-cular events. Background Despite the well-characterised association between sweetened beverage intake and development of cardio-metabolic risk factors, the relationship between sweetened beverage intake and cardiovascular disease and mortality is controversial. A systematic review and meta-analysis was conducted to evaluate the relationship between sweetened beverages and car-diovascular events and mortality. Methods Medline and EMBASE were searched in July 2015 for studies that considered soft drink intake and their association with risk of mortality, coronary heart disease (CHD) or stroke. Pooled risk ratios for adverse outcomes were calculated using inverse variance with a random effects model, and het-erogeneity was assessed using the I 2 statistic. Results 8 studies with 308,810 participants (34-75 years) were included in the review. Pooled results suggest a significant increase in stroke RR 1.13 95% CI 1.02-1.24, and CHD RR 1.22 95% CI 1.14-1.30 with...

Food groups and risk of coronary heart disease, stroke and heart failure: A systematic review and dose-response meta-analysis of prospective studies

“…There is evidence that SSB intake is related to vascular risk factors, whereas associations with CVD were less consistent (Keller et al 2015) and possibly a consequence of SSB consumption being a surrogate for adverse health behaviours (Narain et al 2016). Our meta-analyses add moderate evidence for a risk-increasing association between SSB intake and CHD and stroke.…”

Artificially Sweetened Beverages and the Response to the Global Obesity Crisis

“…Systematic reviews of observational studies indicate that ASB intake is positively associated with increased body mass index in both children [34] and adults [6,35] and to cardiometabolic disease risk (e.g., type 2 diabetes [6] and stroke [36]). However, findings from observational studies might be biased by residual confounding, due to the clustering of lifestyle factors, and reverse causality, as overweight/obese people are more likely to consume ASBs in an attempt to control weight [37].…”

Associations of 100% fruit juice versus whole fruit with hypertension and diabetes risk in postmenopausal women: Results from the Women's Health Initiative

“…Our findings that consuming moderate amounts of 100% fruit juice is not associated with hypertension and diabetes risk stand in contrast to evidence linking consumption of moderate amounts of sugar-sweetened beverages to these diseases. 5, 28–30 Our results suggest that consuming ≤ 8 oz./d of 100% fruit juice, as recommended by the Dietary Guidelines for Americans, does not increase risk of hypertension or diabetes.…”

“…2 In meta-analyses comparing the highest versus lowest quantiles of SSB consumption, high SSB consumers had a 12% increased risk of hypertension, xxvi 26% increased risk of type 2 diabetes, xxvii and 19% increased risk of cardiovascular disease. xxviii …”