Added Sugar Consumption Associated with an Increased Risk of CVD

by | Jan 27, 2025 | 2024, Cardiovascular Health, Recent Articles, Sweeteners

Written by Chrystal Moulton, Science Writer. A significant risk of ischemic stroke was observed among participants whose sugar intake was >15-20% of energy intake (HR = 1.09, P<0.01).

sugarSugar consumption is a modifiable risk factor for preventing many chronic diseases. Added sugar is associated with metabolic syndrome, obesity, poor dental health, and cardiovascular diseases1,2. One study from the European Food Safety Authority reported a dose-response between sugar consumption and the risk of obesity and dyslipidemia3. Since previous studies on the effect of added sugar on chronic disease risk focused mainly on sugar-sweetened beverages4-6, researchers in the current analysis focused on the effect of total sugar consumption and the risk of ischemic and hemorrhagic stroke, atrial fibrillation, myocardial infarction, heart failure, aortic stenosis, and abdominal aortic aneurysm7.

Researchers utilized data from 2 cohort studies for this analysis: The Swedish Mammography Cohort and the Cohort of Swedish Men. In both studies, participants completed identical questionnaires in 1997, 2008, and 2009 related to health, lifestyle factors, and diet. Data from 1997 served as the baseline for this analysis. Participant data was excluded if they had cancer, diabetes, extreme energy intakes, missing or incorrect ID, or if they died before January 1st, 1998. Semiquantitative food frequency questionnaire was given in 1997 and 2009 to gather average intakes of foods and estimating sugar intakes from all foods consumed. Participants were followed until death or end of follow-up on December 31st, 2019. Hazard ratios were calculated to assess the association between sugar consumption and the risk of ischemic and hemorrhagic stroke, atrial fibrillation, myocardial infarction, heart failure, aortic stenosis, and abdominal aortic aneurysm.

Initially, 69,705 participants were included in this analysis after applying initial exclusion criteria. Average age was 59.9 years old with mean added sugar intake of 9.1% of energy intake. Average BMI was 25.3 kg/m2. After applying exclusion criteria for extreme energy intake, data from 42,327 participants were analyzed for this study. 25,739 participants were diagnosed with at least one of the targeted CVD outcomes investigated in this analysis. By the end of the follow up period (December 31, 2019), researchers observed:

  • 1,664 cases of hemorrhagic stroke
  • 6,912 cases of ischemic stroke
  • 10,090 cases of heart failure
  • 13,167 cases of atrial fibrillation
  • 1,872 cases of aortic stenosis
  • 6,635 cases of myocardial infarction
  • 1,575 cases of abdominal aortic aneurysm

Researchers found a significant positive association between added sugar intake and ischemic stroke and abdominal aortic aneurysm after adjusting for all confounders. For other observed outcomes, significant associations were observed based on the source of the sugar (i.e. toppings, treats, or sugar-sweetened beverages)[data in supplementary tables 3-9]. A significant risk of ischemic stroke was observed among participants whose sugar intake was >15-20% of energy intake (HR = 1.09, P<0.01). Similarly, researchers observed a significant risk of abdominal aortic aneurysm starting from sugar intake >10-15% of energy intake (HR= 1.09, P<0.01) with the highest risk at sugar intake > 20% of energy intake (HR = 1.31, P<0.01). Interestingly, researchers also observed a negative association between sugar intakes >5-7.5% of energy intake and heart failure, aortic stenosis, ischemic stroke, myocardial infarction, and atrial fibrillation (P=0.05) compared to baseline intake (<5% of energy intake). Positive linear trends were observed between sugar-sweetened beverages and ischemic stroke, abdominal aortic aneurysm, heart failure, and atrial fibrillation (P trend<0.001). Negative associations were observed between treats and all outcomes (P trend < 0.01). While toppings were negatively associated with aortic stenosis and heart failure and positively associated with abdominal aortic aneurysm (P trend < 0.01). Sensitivity analysis reported similar results upon analysis of participants with complete data.

Results from this analysis suggests a positive correlation between added sugar intake and the risk of ischemic and hemorrhagic stroke, atrial fibrillation, myocardial infarction, heart failure, aortic stenosis, and abdominal aortic aneurysm depending on % of sugar intake to total energy intake and the source of added sugar intake. Additional studies will be needed to understand the implications of varying sources of sugar on CVD risk.

Source: Janzi, Suzanne, Esther González-Padilla, Stina Ramne, Sara Bergwall, Yan Borné, and Emily Sonestedt. “Added sugar intake and its associations with incidence of seven different cardiovascular diseases in 69,705 Swedish men and women.” Frontiers in Public Health 12 (2024): 1452085.

© 2024 Janzi, Gonzalez-Padilla, Ramne, ´Bergwall, Borne and Sonestedt. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or
reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice.

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Posted January 27, 2025.

Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.

References:

  1. Blomhoff R, Andersen R, Arnesen EK, et al. Nordic Nutrition Recommendations 2023: integrating environmental aspects. Nordic Council of Ministers; 2023.
  2. Phillips JA. Dietary Guidelines for Americans, 2020-2025. Workplace Health Saf. Aug 2021;69(8):395. doi:10.1177/21650799211026980
  3. Turck D, Bohn T, Castenmiller J, et al. Tolerable upper intake level for dietary sugars. Efsa j. Feb 2022;20(2):e07074. doi:10.2903/j.efsa.2022.7074
  4. Khan TA, Tayyiba M, Agarwal A, et al. Relation of Total Sugars, Sucrose, Fructose, and Added Sugars With the Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies. Mayo Clin Proc. Dec 2019;94(12):2399-2414. doi:10.1016/j.mayocp.2019.05.034
  5. Bergwall S, Johansson A, Sonestedt E, Acosta S. High versus low-added sugar consumption for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. Jan 5 2022;1(1):Cd013320. doi:10.1002/14651858.CD013320.pub2
  6. Correction to: Rina Ruolin Yan, Chi Bun Chan, Jimmy Chun Yu Louie, Current WHO recommendation to reduce free sugar intake from all sources to below 10% of daily energy intake for supporting overall health is not well supported by available evidence, The American Journal of Clinical Nutrition, Volume 116, Issue 1, July 2022, Pages 15-39, https://doi.org/10.1093/ajcn/nqac084. Am J Clin Nutr. Oct 6 2022;116(4):1187. doi:10.1093/ajcn/nqac231
  7. Janzi S, González-Padilla E, Ramne S, Bergwall S, Borné Y, Sonestedt E. Added sugar intake and its associations with incidence of seven different cardiovascular diseases in 69,705 Swedish men and women. Front Public Health. 2024;12:1452085. doi:10.3389/fpubh.2024.1452085