In the Journals

Artificially sweetened beverages increase risk for stroke in women

Hannah Gardener
Hannah Gardener

Patients who had a high intake of artificially sweetened beverages had increased risks for stroke, CHD, small artery occlusion ischemic stroke and all-cause mortality, according to a study published in Stroke.

“Many well-meaning people, especially those who are overweight or obese, drink low-calorie sweetened drinks to cut calories in their diet,” Yasmin Mossavar-Rahmani, PhD, associate professor of clinical epidemiology and population health at Albert Einstein College of Medicine in the Bronx, New York, said in a press release. “Our research and other observational studies have shown that artificially sweetened beverages may not be harmless, and high consumption is associated with a higher risk of stroke and heart disease.”

Women’s Health Initiative data

Researchers analyzed data from 81,714 women aged 50 to 79 years from the Women’s Health Initiative observational study. Women had a clinic visit at enrollment in which they completed questionnaires and were asked to bring their pill bottles. The visit also included physical examinations and blood draws.

Another clinic visit was performed 3 years later, when women were also asked about their artificially sweetened beverage intake. Women were categorized by the frequency of artificially sweetened beverage consumption: never or less than one a week (n = 52,317), one to four drinks a week (n = 15,819), five to seven drinks a week (n = 9,382) and at least two a day (n = 4,196). After this visit, women were followed up for a mean of 11.9 years.

The outcomes of interest were ischemic stroke, overall stroke, ischemic stroke, hemorrhagic stroke, CHD and death.

After controlling for multiple covariates, women with the highest levels of artificially sweetened beverage consumption were more likely to have all endpoints except for hemorrhagic stroke. Endpoints included ischemic stroke (HR = 1.31; 95% CI, 1.06-1.63), fatal and nonfatal stroke (HR = 1.23; 95% CI, 1.02-1.47), all-cause mortality (HR = 1.16; 95% CI, 1.07-1.26) and CHD (HR = 1.29; 95% CI, 1.11-1.51).

Additional analyses

High consumption of artificially sweetened beverages increased the risk for small artery occlusion ischemic stroke after women with CVD or diabetes were excluded (HR = 2.44; 95% CI, 1.47-4.04). Women with BMI greater than 30 kg/m2 and high consumption of artificially sweetened beverages had a significantly increased risk for ischemic stroke (HR = 2.03; 95% CI, 1.38-2.98).

“Although these findings require replication, potential mechanisms explaining these findings are manifold,” Mossavar-Rahmani and colleagues wrote. “On the one hand, residual confounding of traditional risk factors such as hypertension and (undetected) diabetes mellitus, as well as reverse causality, may contribute to this association; on the other hand, it is known that noncaloric artificial sweeteners display unfavorable metabolic effects, which may put consumers at additional risk.”

Mitchell S.V. Elkind
Mitchell S.V. Elkind

In a related editorial, Hannah Gardener, ScD, assistant scientist in the department of neurology at University of Miami Miller School of Medicine, and Mitchell S.V. Elkind, MD, MS, MPhil, professor of neurology and epidemiology at Columbia University, wrote: “Until we have more evidence to better understand who, if anyone, benefits from consumption of [artificially sweetened beverages], we should emphasize water as the healthiest substitute for [sugar-sweetened beverages]. If [artificially sweetened beverage] consumption is used to wean off [sugar-sweetened beverages], it should be viewed as a time-limited intermediate in the transition to water and other healthier beverages.” – by Darlene Dobkowski

Disclosures: The Women’s Health Initiative program is funded by the NHLBI, NIH and HHS. Mossavar-Rahmani, Gardener and Elkind report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Hannah Gardener
Hannah Gardener

Patients who had a high intake of artificially sweetened beverages had increased risks for stroke, CHD, small artery occlusion ischemic stroke and all-cause mortality, according to a study published in Stroke.

“Many well-meaning people, especially those who are overweight or obese, drink low-calorie sweetened drinks to cut calories in their diet,” Yasmin Mossavar-Rahmani, PhD, associate professor of clinical epidemiology and population health at Albert Einstein College of Medicine in the Bronx, New York, said in a press release. “Our research and other observational studies have shown that artificially sweetened beverages may not be harmless, and high consumption is associated with a higher risk of stroke and heart disease.”

Women’s Health Initiative data

Researchers analyzed data from 81,714 women aged 50 to 79 years from the Women’s Health Initiative observational study. Women had a clinic visit at enrollment in which they completed questionnaires and were asked to bring their pill bottles. The visit also included physical examinations and blood draws.

Another clinic visit was performed 3 years later, when women were also asked about their artificially sweetened beverage intake. Women were categorized by the frequency of artificially sweetened beverage consumption: never or less than one a week (n = 52,317), one to four drinks a week (n = 15,819), five to seven drinks a week (n = 9,382) and at least two a day (n = 4,196). After this visit, women were followed up for a mean of 11.9 years.

The outcomes of interest were ischemic stroke, overall stroke, ischemic stroke, hemorrhagic stroke, CHD and death.

After controlling for multiple covariates, women with the highest levels of artificially sweetened beverage consumption were more likely to have all endpoints except for hemorrhagic stroke. Endpoints included ischemic stroke (HR = 1.31; 95% CI, 1.06-1.63), fatal and nonfatal stroke (HR = 1.23; 95% CI, 1.02-1.47), all-cause mortality (HR = 1.16; 95% CI, 1.07-1.26) and CHD (HR = 1.29; 95% CI, 1.11-1.51).

Additional analyses

High consumption of artificially sweetened beverages increased the risk for small artery occlusion ischemic stroke after women with CVD or diabetes were excluded (HR = 2.44; 95% CI, 1.47-4.04). Women with BMI greater than 30 kg/m2 and high consumption of artificially sweetened beverages had a significantly increased risk for ischemic stroke (HR = 2.03; 95% CI, 1.38-2.98).

“Although these findings require replication, potential mechanisms explaining these findings are manifold,” Mossavar-Rahmani and colleagues wrote. “On the one hand, residual confounding of traditional risk factors such as hypertension and (undetected) diabetes mellitus, as well as reverse causality, may contribute to this association; on the other hand, it is known that noncaloric artificial sweeteners display unfavorable metabolic effects, which may put consumers at additional risk.”

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Mitchell S.V. Elkind
Mitchell S.V. Elkind

In a related editorial, Hannah Gardener, ScD, assistant scientist in the department of neurology at University of Miami Miller School of Medicine, and Mitchell S.V. Elkind, MD, MS, MPhil, professor of neurology and epidemiology at Columbia University, wrote: “Until we have more evidence to better understand who, if anyone, benefits from consumption of [artificially sweetened beverages], we should emphasize water as the healthiest substitute for [sugar-sweetened beverages]. If [artificially sweetened beverage] consumption is used to wean off [sugar-sweetened beverages], it should be viewed as a time-limited intermediate in the transition to water and other healthier beverages.” – by Darlene Dobkowski

Disclosures: The Women’s Health Initiative program is funded by the NHLBI, NIH and HHS. Mossavar-Rahmani, Gardener and Elkind report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.