Drinking More Than Two Soft Drinks per Day Ups HF Risk in Men, Says Swedish Study

Deborah Brauser

November 06, 2015

STOCKHOLM, SWEDEN — Another study has found an association between sugary drinks and negative coronary outcomes. According to new research from Sweden, men who make a practice of drinking sweetened beverages may be putting themselves at increased risk for heart failure (HF)[1].

The population-based cohort study of more than 42,000 middle-aged and older men showed that those who regularly drank at least two of these beverages a day were 23% more likely to develop HF during 11 years of follow-up vs those who weren't consumers of the sweetened drinks at all (P for trend <0.001). This association held even after excluding those with diabetes (P<0.001).

Dr Iffat Rahman (Karolinska Institutet, Stockholm, Sweden) and colleagues write that although more research is now needed, including more prospective studies, their results "could aid in heart-failure risk-prevention strategies by, for example, improving diet recommendations."

The findings were published online November 2, 2015 in Heart.

Drs Miguel A Martínez-González and Miguel Ruiz-Canela (both from the University of Navarra, Pamplona, Spain) write in an accompanying editorial that the study highlights the role that a single, highly consumed element can have on HF globally[2].

"Based on the results, the best message for a preventive strategy would be to recommend an occasional consumption of [sweetened beverages] or to avoid them altogether," they summarize.

Risk of Heart Failure

As reported by heartwire from Medscape, past research has shown an association between sugary drinks and increased CVD risk, as well as an increased risk for obesity and type 2 diabetes.

For the current study, the investigators wanted to specifically look for a possible link between sweetened beverages and HF risk.

They investigated data on 42,400 men between the ages of 45 and 79 years who were participants in the population-based Cohort of Swedish Men (COSM). All filled out a food frequency questionnaire, as well as a questionnaire on physical activity and lifestyle, in 1997. For beverages in this study, one serving was defined as one glass/200 mL. Fruit juice was not considered to be a sweetened beverage.

The participants were followed for a mean of 11.7 years, during which there were 4113 HF events. This included 3604 hospitalizations and 509 deaths.

After multivariable adjustment, there was a significant association between HF risk and drinking two or more soft drink servings per day vs drinking no soft drinks (hazard ratio [HR] 1.23, 95% CI 1.12–1.35).

After researchers excluded the men who developed HF during the follow-up's first 5 years, the HR for heart failure for those who drank at least two sweetened beverages was 1.25 (95% CI 1.12–1.40). The HR was 1.21 (95% CI 1.10–1.34) for the two or more drinks/per day group members who were not diabetic.

There were no significant associations found between any amount of beverage intake and smoking status, being overweight, or being over the age of 65 years.

The investigators cited several study limitations, including that the food frequency questionnaire was self-administered, the observational study means causation cannot be interpreted, and there were no biomarkers collected, such as blood pressure, insulin, or glucose measurements.

In addition, "the sweetened-beverage consumption in the COSM was about the same as in other European populations but lower than in US populations," write the researchers. "Thus, our study findings might not apply to certain countries, younger age groups, or women."

"Reduce or Eliminate Intake"

In their editorial, Martínez-González and Ruiz-Canela note surprise that there aren't more studies examining the relationship between nutritional factors and HF — especially because HF prevalence and mortality represents "a staggering cardiovascular epidemic with the potential to become a global public-health crisis."

In addition, "no previous study had ever assessed the association between [sweetened beverages] and HF as a primary analysis," they write, adding that more research is needed, especially taking into account the etiology and severity of HF and assessing long-term impact of younger individuals' intake of these beverages.

Although the editorialists note that "these novel findings complete our knowledge" about the impact these beverages may have on the development of CVD, it may just be one part of the need for a healthier diet.

"Overall dietary patterns better represent the broader picture of food habits and are more important determinants of disease than any isolated food or beverage," they write. Still, recommendations to patients should include reducing or eliminating their intake of this beverage type and "replacing them with water to comply with the requirements for a good hydration."

The study was funded by the Swedish Research Council Committee for Medicine and by its Committee for Infrastructure. The study authors and editorialists report no relevant financial relationships.

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