Diet Soft Drink Consumption is Associated with an Increased Risk of Vascular Events in the Northern Manhattan Study

Hannah Gardener, Tatjana Rundek, Matthew Markert, Clinton B. Wright, Mitchell S. V. Elkind and Ralph L. Sacco FROM ABSTRACT: BACKGROUND: Diet and regular soft drinks have been associated with diabetes and the metabolic syndrome, and regular soft drinks with coronary heart disease. OBJECTIVE: To determine the association between soft drinks and combined vascular events, including stroke. KEY RESULTS: Controlling for age, sex, race/ethnicity, education, smoking, physical activity, alcohol consumption, BMI, daily calories, consumption of protein, carbohydrates, total fat, saturated fat, and sodium, those who drank diet soft drinks daily (vs. none) had an increased risk of vascular events [by 43%], and this persisted after controlling further for the metabolic syndrome, peripheral vascular disease, diabetes, cardiac disease, hypertension, and hypercholesterolemia. There was no increased risk of vascular events associated with regular soft drinks or light diet soft drink consumption. CONCLUSIONS: Daily diet soft drink consumption was associated with several vascular risk factors and with an increased risk for vascular events. KEY POINTS FROM THIS STUDY: 1) This is the first study to examine the association between diet soft drink consumption and incident combined vascular events, including stroke. 2 2) The association between sugar-sweetened soft drinks and obesity, insulin sensitivity, and hypertension may be attributed to their high calorie and sugar load, and lack of nutrients. 3) Artificially-sweetened “diet” soft drinks have been marketed as healthier alternatives due to their lack of calories. However, recent studies suggested that diet soft drink consumption may also be associated with health consequences, particularly type 2 diabetes and the metabolic syndrome, risk factors for cardiovascular disease, ischemic stroke, and all-cause mortality. 4) Frequent diet soft drink consumption was uniquely associated with white race, former smoking, hypertension, elevated blood sugar, lower HDL, elevated triglycerides, increased waist circumference, BMI, peripheral vascular disease, previous cardiac disease, and the metabolic syndrome. 5) Frequent regular soft drink consumption was uniquely associated with male sex, black race, current smoking, carbohydrate consumption, greater diastolic BP, and lower prevalences of diabetes and hypercholesterolemia. 6) We found no association between regular soft drink consumption and risk of combined vascular events, adjusting for demographic and vascular risk factors. 7) Those who drank diet soft drinks daily had a 43% increased risk of vascular events as compared to those who did not drink diet soft drinks. The data of this study also tended to show that the more diet sodas consumed per day the greater the incidence of vascular events. 8) Light diet soft drink users did not have a significantly increased risk of vascular events. 9) Daily diet soft drink consumption was associated with a 66% increased risk of myocardial infarction as compared to no diet soft drink consumption. [The greatest risk from daily consumption of diet sodas was heart attack]. 10) When the authors excluded all participants who were obese, with a history of diabetes or metabolic syndrome, there was a 57% increased risk of vascular events among those who consumed regular soft drinks daily, and a 59% increased risk among those who consumed diet soft drinks daily. [This means that even if you are healthier, either daily consumption of regular sodas or diet sodas are bad for you]. 11) After controlling for these potential confounders, daily diet soft drink consumption at baseline was associated with an increased risk for vascular events during follow-up. 12) There is substantial literature on the negative health consequences of the consumption of sugar-sweetened beverages. 3 13) This study agrees with previous studies that have shown an association between diet soft drink consumption and metabolic syndrome. 14) Diet sodas are significantly associated with elevated blood glucose levels, increased waist circumference and metabolic syndrome. [Ironically, people consume diet sodas precisely to avoid these problems]. 15) The health consequences associated with regular soft drink consumption may be attributed to its high caloric content, glycemic load and consequential inflammatory responses, and added sweeteners such as high fructose corn syrup, which may increase the risk of vascular disease due to its association with blood uric acid levels and triacylglycerol concentrations. 16) Studies show that consumption of artificially sweetened drinks is associated with gaining weight. 17) Consumption of artificial sweeteners may weaken the ability to anticipate the caloric content of foods, leading to increased food intake and gain in body weight. 18) The caramel coloring of both diet and regular soft drinks may contribute to increased levels of proinflammatory advanced glycation end products. [Caramel colored sodas in and of themselves are bad for you].