A Soda a Day Raises CHD Risk

by 20%
From : http://www.medscape.com/viewarticle/760100

Lisa Nainggolan
Lisa Nainggolan is a journalist for theheart.org, part of the WebMD Professional Network. She has been with
theheart.org since 2000. Previously, she was science editor of Scrip World Pharmaceutical News, covering
news about research and development in the pharmaceutical industry, and a consultant editor of Scrip
Magazine. Graduating in physiology from Sheffield University, UK, she began her career as a poisons
information specialist at Guy's Hospital before becoming a medical journalist in 1995. She can be reached
at LNainggolan@webmd.net.
Disclosure: Lisa Nainggolan has disclosed no relevant financial relationships.

March 12, 2012 (Boston, Massachusetts) Sugary drinks are

associated with an increased risk of coronary heart disease (CHD) as
well as some adverse changes in lipids, inflammatory factors, and
leptin, according to a new analysis of men participating in the Health
Professionals Follow-up Study, reported by Dr Lawrence de
Koning (Children's Hospital Boston, MA) and colleagues online March
12, 2012 in Circulation [1].
"Even a moderate amount of sugary beverage consumption we are
talking about one can of soda every day is associated with a
significant 20% increased risk of heart disease even after adjusting for
a wide range of cardiovascular risk factors," senior author Dr Frank B
Hu (Harvard School of Public Health, Boston, MA) told heartwire . "The
increased risk is quite substantial, and I think has important publichealth implications given the widespread consumption of soda, not
only in the US but also increasing very rapidly in developing countries."
The increased risk is quite substantial, and I think has
important public-health implications given the widespread
consumption of soda.
The researchers did not find an increased risk of CHD with artificially
sweetened beverages in this analysis, however. "Diet soda has been
shown to be associated with weight gain and metabolic diseases in
previous studies, even though this hasn't been substantiated in our
study," says Hu. "The problem with diet soda is its high-intensity sweet
taste, which may condition people's taste. It's still an open question
whether diet soda is an optimal alternative to regular soda; we need
more data on this. "

Hu says water is the best thing to drink, or coffee or tea. Fruit juice is
"not a very good alternative, because of the high amount of sugar," he
adds, although if diluted with water, "it's much better than a can of
soda," he notes.
And Hu says although the current results apply only to men, prior data
from his group in women in the Nurses' Health Study [from 2009]
were comparable, "which really boosts the credibility of the findings."
Inflammation could be a pathway for impact of soda upon CHD
risk
Hu and colleagues explain that while much research has shown a link
between the consumption of sugar-sweetened beverages and type 2
diabetes, few studies have looked at the association of these drinks
with CHD.
Hence, they analyzed the associations of cumulatively averaged sugarsweetened (eg, sodas) and artificially sweetened (eg, diet sodas)
beverage intake with incident fatal and nonfatal CHD (MI) in 42 883
men in the Health Professionals Follow-up study. Beginning in 1986 and
every two years until December 2008, participants answered
questionnaires about diet and other health habits. A blood sample was
provided midway through the study.
There were 3683 CHD cases over 22 years of follow-up. Those in the
top quartile of sugar-sweetened-beverage intake had a 20% higher
relative risk of CHD than those in the bottom quartile (RR 1.20; p for
trend < 0.001) after adjustment for age, smoking, physical activity,
alcohol, multivitamins, family history, diet quality, energy intake, bodymass index, preenrollment weight change, and dieting.
Adjustment for self-reported high cholesterol, high triglycerides, high
blood pressure, and diagnosed type 2 diabetes only slightly attenuated
these associations, which suggests that drinking soda "may impact on
CHD risk above and beyond traditional risk factors," say the
researchers.
Consumption of artificially sweetened drinks was not significantly
associated with CHD (multivariate RR 1.02; p for trend=0.28).
Intake of sugar-sweetened drinks, but not artificially sweetened ones,
was also significantly associated with increased triglycerides and
several circulating inflammatory factors including C-reactive protein,
interleukin 6 (IL-6), and tumor-necrosis-factor receptor 1 (TNFr1) as

well as decreased HDL cholesterol, lipoprotein (a) (Lp[a]), and leptin (p

< 0.02).
"Inflammation is a key factor in the pathogenesis of cardiovascular
disease and cardiometabolic disease and could represent an additional
pathway by which sugar-sweetened beverages influence risk," say Hu
et al.
Cutting consumption of soda is one of easiest behaviors to
change
Hu says that one of the major constituents of soda, high-fructose corn
syrup, is subsidized in the US, making such drinks "ridiculously cheap"
and helping explain why consumption is so high, particularly in lower
socioeconomic groups.
Doctors should be advising people with heart disease or at risk
to cut back on sugary beverages; it's almost a no-brainer.
"Doctors should set an example for their patients first," he stresses.
"Then, for people who already have heart disease or who are at high
risk, physicians should be advising them to cut back on sugary
beverages; it's almost a no-brainer, like recommending that they stop
smoking and do more exercise. The consumption of sugary beverages
is a relatively easy behavior to change."
And although this particular study included mostly white subjects and
there are few data on the risk of cardiovascular disease associated with
the consumption of soda in people of other ethnicities, there are data
on its effect on type 2 diabetes in these groups, he says.
"It has been shown for minority groups such as African Americans
and Asians that they are more susceptible to the detrimental
effects" of sugary drinks on diabetes incidence, he notes.
The authors report no conflicts of interest.

References
1. de Koning L, Malik VS, Kellogg MD et al. Sweetened beverage
consumption, incident coronary heart disease and biomarkers of
risk in men. Circulation 2012; DOI:
10.1161/CIRCULATIONAHA.111.067017. Available at:
http://circ.ahajournals.org.