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Evidence-Based Diabetes Management May 2014

Diet Drinks Linked to Heart Trouble for Older Women

Mary K. Caffrey
American College of Cardiology 2014
Evidence linking sugar-sweetened sodas to cardiovascular damage has been the subject of studies presented by the American Diabetes Association and even 60 Minutes.1 Now, diet sodas are getting their turn.

At the 63rd Scientific Sessions of the American College of Cardiology held in Washington, DC, Ankur Vyas, MD, of the University of Iowa Hospitals and Clinic, Iowa City, Iowa, presented results showing that older women who drink at least 2 diet drinks per day are more likely to have a heart attack, stroke, or other cardiovascular issue.

Vyas’ March 30, 2014, talk, “Diet Drink Consumption and the Risk of Cardiovascular Events: A Report from the Women’s Health Initiative,” involved data from 59,614 women with an average age of 62 years who were followed for an average of 8.7 years.2

In his presentation, Vyas said the women were divided into 4 groups based on diet drink consumption, with those who consumed at least 2 drinks per day forming 1 group; those consuming 5 to 7 drinks per week forming another; those having 1 to 4 drinks per week forming a third; and those having 0 to 3 drinks per month making up the fourth group, or reference group.

The primary outcome—a composite of incidence of coronary heart disease, congestive heart failure, heart attack, coronary revascularization procedure, ischemic stroke, peripheral arterial disease, and cardiovascular death—occurred in 8.5% of the women consuming 2 or more drinks per day, followed by 6.9%, 6.8%, and 7.2% in the other 3 groups, respectively.

Vyas said the relationship persisted after adjusting for demographic and cardiovascular risk factors, body mass index, smoking status, physical activity, and salt, cholesterol, and sugar sweetened beverage intake. Women who consumed 2 or more diet drinks per day were younger, but their overall health was worse: they were more likely to smoke, weigh more, and have diabetes or hypertension.

Reasons for the association between higher consumption of diet soda and cardiovascular risk is unclear, but Vyas said it is possible that artificial sweeteners in the drinks may trigger “an increase in desire for sugar-sweetened, energy-dense beverages and foods due to disruption of normal feedback mechanisms.” It appears that those who drink more diet sodas than average already have unhealthy lifestyles, he said, and this relationship merits further study.3

About 1 in 5 people in the United States consume diet drinks on a given day, according to data from the National Health and Nutrition Examination Survey (2009-2010).4 But Vyas cautioned that this particular study only applies to postmenopausal women. To be included in this analysis, women had to have no history of cardiovascular disease and had to be alive 60 or more days from the time of data collection.3

A 2009 study published in Diabetes Care found an association between consumption of diet soda and the incidence of metabolic syndrome and type 2 diabetes mellitus, but the study cautioned that no causality could be determined.5

A commenter at the session noted the irony of Vyas’ results: “Here we have a multibillion-dollar industry promoting health without any outcomes research,” he said. EBDM
References

1. Caffrey MK. Does sugar cause cardiometabolic disease? Stanhope reviews the evidence. Am J Manag Care. 2013;19(SP7):SP247.

2. Vyas A, Rubenstein L, Robinson J, et al. Diet drink consumption and the risk of cardiovascular events: a report from the women’s health initiative. JACC. 2014;64(12, suppl A):Abstract 917- 905.

3. Too many diet drinks may spell heart trouble for older women [press release]. Washington, DC: American College of Cardiology; March 29, 2014. http://acc2014.org/wp-content/uploads/ 2014/03/VYAS_Diet-Drinks_Consumer-Briefing-2_Press-Release_FINAL.pdf. Accessed March 29, 2014.

4. Nutrition Health and Examination Survey. CDC website. http://wwwn.cdc.gov/nchs/nhanes/search/nhanes09_10.aspx. Updated March 27, 2014. Accessed March 30, 2014.

5. Nettleton JA, Lutsey PL, Wang Y, Lima JA, Michos ED, Jacobs DR Jr. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the multi-ethnic study of atherosclerosis
(MESA). Diabetes Care. 2009;32(4):688-694.
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