Sugar-Sweetened and Artificially Sweetened Beverages Consumption and Risk of Cardiovascular Health

Published:October 13, 2022DOI:



      Sugar-sweetened and artificially sweetened beverages are routinely consumed worldwide. Given their popularity, there has been much debate about the effect that these beverages have on cardiovascular health. We sought to determine the exact relationship between sugar-sweetened and artificially sweetened beverages consumption on cardiovascular health.


      All studies that reported an association between sugar-sweetened/artificially sweetened beverages consumption and cardiovascular health were extracted from database inception to September 2022 using keywords from several databases. We used the DerSimonian & Laird random-effects method for the analysis.


      Of the total 16 prospective studies, 1,405,375 individuals were followed for a median follow-up of 14.8 years. Compared with low sugar-sweetened and artificially sweetened beverage consumption, a higher consumption of sugar-sweetened and artificially sweetened beverages was associated with greater cardiovascular outcomes (hazard ratio [HR] of 1.27, 95% confidence interval [CI] of 1.16-1.40 and risk ratios of 1.16, 95% CI of 1.02-1.33). Similarly, compared with low artificially sweetened beverages consumption, a higher consumption of artificially sweetened beverages was associated with greater cardiovascular outcomes (HR of 1.32, 95% CI of 1.12-1.57). Likewise, compared with low sugar-sweetened beverages consumption, a higher consumption of sugar-sweetened beverages was associated with greater cardiovascular outcomes (HR of 1.21, 95% CI of 1.07-1.37 and risk ratios of 1.22, 95% CI of 1.09-1.35).


      Increasing consumption of sugar-sweetened and artificially sweetened beverages may be correlated with an increased risk of developing cardiovascular/vascular complications and mortality, albeit without causality of cardiovascular/vascular morbidity.


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        • Chevinsky JR
        • Lee SH
        • Blanck HM
        • Park S
        Prevalence of self-reported intake of sugar-sweetened beverages among US adults in 50 states and the District of Columbia, 2010 and 2015.
        Prev Chronic Dis. 2021; 18: E35
        • Rahmani
        • et al.
        Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women’s Health Initiative.
        Stroke. 2019;
        • Chazelas
        • et al.
        Sugary Drinks, Artificially-Sweetened Beverages, and Cardiovascular Disease in the NutriNet-Santé Cohort.
        J Am Coll Cardiol. 2020;
        • Collin
        • et al.
        Association of Sugary Beverage Consumption With Mortality Risk in US Adults: A Secondary Analysis of Data From the REGARDS Study.
        JAMA Netw Open. 2019;
        • Pacheco
        • et al.
        Sugar-Sweetened Beverage Intake and Cardiovascular Disease Risk in the California Teachers Study.
        J Am Heart Assoc. 2020;
        • Vyas
        • et al.
        Diet drink consumption and the risk of cardiovascular events: a report from the Women’s Health Initiative.
        J Gen Intern Med. 2015;
        • Debras
        • et al.
        Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort.
        BMJ. 2022;
        • Mullee
        • et al.
        Association Between Soft Drink Consumption and Mortality in 10 European Countries.
        JAMA Intern Med. 2019;
        • Pase
        • et al.
        Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia: A Prospective Cohort Study.
        Stroke. 2017;
        • Eshak
        • et al.
        Soft drink intake in relation to incident ischemic heart disease, stroke, and stroke subtypes in Japanese men and women: the Japan Public Health Centre-based study cohort I.
        Am J Clin Nutr. 2012;
        • Barrington
        • et al.
        Mortality outcomes associated with intake of fast-food items and sugar-sweetened drinks among older adults in the Vitamins and Lifestyle (VITAL) study.
        Public Health Nutr. 2016;
        • Gardener
        • et al.
        Diet soft drink consumption is associated with an increased risk of vascular events in the Northern Manhattan Study.
        J Gen Intern Med. 2012;
        • Koning
        • et al.
        Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men.
        Circulation. 2012;
        • Fung
        • et al.
        Sweetened beverage consumption and risk of coronary heart disease in women.
        Am J Clin Nutr. 2009;
        • Rahman
        • et al.
        The relationship between sweetened beverage consumption and risk of heart failure in men.
        Heart. 2015;
        • Bernstein
        • et al.
        Soda consumption and the risk of stroke in men and women.
        Am J Clin Nutr. 2012;
        • Larsson
        • et al.
        Sweetened beverage consumption is associated with increased risk of stroke in women and men.
        J Nutr. 2014;
        • Salgado
        • et al.
        Projected impact of a reduction in sugar-sweetened beverage consumption on diabetes and cardiovascular disease in Argentina: A modeling study.
        PLoS Med. 2020;
        • Keller
        Substitution of sugar-sweetened beverages for other beverages and the risk of developing coronary heart disease: Results from the Harvard Pooling Project of Diet and Coronary Disease.
        Prev Med. 2020;
        • Janzi
        • et al.
        Associations Between Added Sugar Intake and Risk of Four Different Cardiovascular Diseases in a Swedish Population-Based Prospective Cohort Study.
        Front Nutr. 2020;
        • Liu
        • et al.
        Dietary sugar intake was associated with increased body fatness but decreased cardiovascular mortality in Chinese elderly: an 11-year prospective study of Mr and Ms OS of Hong Kong.
        Int J Obes (Lond). 2018;
        • Sonestedt
        • et al.
        The association between carbohydrate-rich foods and risk of cardiovascular disease is not modified by genetic susceptibility to dyslipidemia as determined by 80 validated variants.
        PLoS One. 2015;
        • Odegaard
        Beverage habits and mortality in Chinese adults.
        J Nutr. 2015;
        • Yang
        Added sugar intake and cardiovascular diseases mortality among US adults.
        JAMA Intern Med. 2014;
        • Janssens JP
        • Shapira N
        • Debeuf P
        • et al.
        Effects of soft drink and table beer consumption on insulin response in normal teenagers and carbohydrate drink in youngsters.
        Eur J Cancer Prev. 1999; 8: 289-295
        • Malik VS
        • Hu FB
        Sugar-sweetened beverages and cardiometabolic health: an update of the evidence.
        Nutrients. 2019; 11: 1840
        • Schulze MB
        • Manson JE
        • Ludwig DS
        • et al.
        Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women.
        JAMA. 2004; 292: 927-934
        • Ludwig DS
        The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease.
        JAMA. 2002; 287: 2414-2423
        • Esposito K
        • Nappo F
        • Marfella R
        • et al.
        Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress.
        Circulation. 2002; 106: 2067-2072
        • Hotamisligil GS
        Inflammation and metabolic disorders.
        Nature. 2006; 444: 860-867
        • Liu S
        • Manson JE
        • Buring JE
        • Stampfer MJ
        • Willett WC
        • Ridker PM
        Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women.
        Am J Clin Nutr. 2002; 75: 492-498
        • Miller M
        • Stone NJ
        • Ballantyne C
        • et al.
        Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association.
        Circulation. 2011; 123: 2292-2333
        • Bray GA
        • Popkin BM
        Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: health be damned! Pour on the sugar.
        Diabetes Care. 2014; 37: 950-956
        • Dhingra R
        • Sullivan L
        • Jacques PF
        • et al.
        Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community.
        Circulation. 2007; 116: 480-488
        • Choi HK
        • Willett W
        • Curhan G
        Fructose-rich beverages and risk of gout in women.
        JAMA. 2010; 304: 2270-2278
        • Imamura F
        • O'Connor L
        • Ye Z
        • et al.
        Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction.
        BMJ. 2015; 351: h3576
        • Drewnowski A
        • Rehm CD
        The use of low-calorie sweeteners is associated with self-reported prior intent to lose weight in a representative sample of US adults.
        Nutr Diabetes. 2016; 6: e202
        • Basson AR
        • Rodriguez-Palacios A
        • Cominelli F
        Artificial sweeteners: history and new concepts on inflammation.
        Front Nutr. 2021; 8746247
        • Lee JJ
        • Khan TA
        • McGlynn N
        • et al.
        Relation of change or substitution of low- and no-calorie sweetened beverages with cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies.
        Diabetes Care. 2022; 45: 1917-1930
        • Higgins KA
        • Mattes RD
        A randomized controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesity.
        Am J Clin Nutr. 2019; 109: 1288-1301
        • Nadolsky KZ
        COUNTERPOINT: artificial sweeteners for obesity–better than sugary alternatives; potentially a solution.
        Endocr Pract. 2021; 27: 1056-1061
        • McGlynn ND
        • Khan TA
        • Wang L
        • et al.
        Association of low- and no-calorie sweetened beverages as a replacement for sugar-sweetened beverages with body weight and cardiometabolic risk: a systematic review and meta-analysis.
        JAMA Netw Open. 2022; 5e222092