High Intake of Sugar-Sweetened Beverages Associated With Coronary Artery Calcium

Deborah Brauser

April 25, 2016

SEOUL, KOREA — Drinking at least one sugar-sweetened carbonated beverage per day during the workweek may increase coronary artery calcium (CAC), new research suggests[1].

A study of more than 22,000 adults in South Korea without prior coronary heart disease showed that those who consumed five or more regular soft drinks per week had a fully adjusted CAC ratio of 1.7 vs the nonconsumers (95% CI 1.0–2.8).

This ratio was adjusted for age, sex, physical activity, smoking, dietary factors, history of hypertension or hypercholesterolemia, and family history of CHD.

"Our findings indicate that the cardiovascular hazards of carbonated-beverage consumption are evident even in the subclinical stages of atherosclerosis," note the investigators, led by Dr Sohyun Chun (Sungkyunkwan University School of Medicine, Seoul, Korea), adding that this type of drink "has become a major public-health and public-policy issue."

The findings were published online April 16, 2016 in the American Heart Journal.

Subclinical CHD

The investigators note that although sugary beverages have been associated before with a variety of adverse conditions, including increased risk of type 2 diabetes, obesity, and CVD, a link with subclinical CHD has remained "unclear."

For the current analysis, they examined data on health screenings conducted between 2011 and 2013 for 22,210 adults (81% men; mean age 40 years) who participated in the Kangbuk Samsung Health Study.

A self-reported, 106-item food frequency questionnaire was used to record consumption of sodas, with one drink equaling 200 mL. The participants were not asked to differentiate between full calorie/low-calorie or caffeinated/noncaffeinated drinks. Cardiac computed tomography was used to measure CAC.

Other measurements included the Korean version of the International Physical Activity Questionnaire and a patient demographics questionnaire.

The average number of sugary drinks consumed per week was 1.2. While 70% of participants reported being carbonated-beverage consumers, only 5% reported drinking at least five of these soft drinks each week. Of all the participants assessed, 11.7% had a CAC score greater than zero.

Generalizable? More Studies Needed

Compared with those who consumed none or very few of these drinks, "those with a higher intake were more likely to be younger, male, current smokers, physically active, and obese," report the investigators. They also had higher total cholesterol, LDL-C, triglyceride, and glucose levels and lower levels of HDL-C, as well as a higher alcohol intake.

When adjusted just for age, sex, and year of exam screening, the CAC score ratio was 1.86 for those who drank five or more of the beverages per week vs those who drank none (95% CI 1.1–3.1).

The CAC ratio went up even more when, in secondary analysis, the researchers excluded those who didn't consume any of these beverages at all. The fully adjusted CAC ratio was 1.97 (95% CI 1.2–3.3) for those who consumed five or more drinks per week vs those who consumed less than one a week.

"A number of cardiometabolic risk factors, including blood pressure, lipids, glucose levels, and [body-mass index] BMI may partially mediate the association," note the investigators.

They also point out that the soft-drink–consumption rate was lower for their study population vs rates reported for Western populations—with one-quarter of US citizens drinking more than one 12-oz can of soda each day, according to the 2005–2008 National Health and Nutrition Examination Survey.

Although "high" levels of consumption were significantly associated with a higher level of CAC in their "large sample of Korean men and women apparently free from clinically evident CVD, cancer, or diabetes," the researchers note that prospective studies in other populations will need to be conducted before knowing if the findings are generalizable.

The study authors report no relevant financial relationships.


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