Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women's Health Initiative

Yasmin Mossavar-Rahmani; Victor Kamensky; JoAnn E Manson; Brian Silver; Stephen R Rapp; Bernhard Haring; Shirley A A Beresford; Linda Snetselaar; Sylvia Wassertheil-Smoller; Women’s Health Initiative (WHI) investigators

doi:10.1161/STROKEAHA.118.023100

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Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women's Health Initiative

Journal article

Open access

Peer reviewed

Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women's Health Initiative

Yasmin Mossavar-Rahmani, Victor Kamensky, JoAnn E Manson, Brian Silver, Stephen R Rapp, Bernhard Haring, Shirley A A Beresford, Linda Snetselaar, Sylvia Wassertheil-Smoller and Women’s Health Initiative (WHI) investigators

Stroke (1970), Vol.50(3), pp.555-562

03/2019

DOI: 10.1161/STROKEAHA.118.023100

PMCID: PMC6538252

PMID: 30802187

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Abstract

Background and Purpose- We examine the association between self-reported consumption of artificially sweetened beverages (ASB) and stroke and its subtypes, coronary heart disease, and all-cause mortality in a cohort of postmenopausal US women. Methods- The analytic cohort included 81 714 women from the Women's Health Initiative Observational Study, a multicenter longitudinal study of the health of 93 676 postmenopausal women of ages 50 to 79 years at baseline who enrolled in 1993 to 1998. This prospective study had a mean follow-up time of 11.9 years (SD of 5.3 years.) Participants who completed a follow-up visit 3 years after baseline were included in the study. Results- Most participants (64.1%) were infrequent consumers (never or <1/week) of ASB, with only 5.1% consuming ≥2 ASBs/day. In multivariate analyses, those consuming the highest level of ASB compared to never or rarely (<1/wk) had significantly greater likelihood of all end points (except hemorrhagic stroke), after controlling for multiple covariates. Adjusted models indicated that hazard ratios and 95% confidence intervals were 1.23 (1.02-1.47) for all stroke; 1.31 (1.06-1.63) for ischemic stroke; 1.29 (1.11-1.51) for coronary heart disease; and 1.16 (1.07-1.26) for all-cause mortality. In women with no prior history of cardiovascular disease or diabetes mellitus, high consumption of ASB was associated with more than a 2-fold increased risk of small artery occlusion ischemic stroke hazard ratio =2.44 (95% confidence interval, 1.47-4.04.) High consumption of ASBs was associated with significantly increased risk of ischemic stroke in women with body mass index ≥30; hazard ratio =2.03 (95% confidence interval, 1.38-2.98). Conclusions- Higher intake of ASB was associated with increased risk of stroke, particularly small artery occlusion subtype, coronary heart disease, and all-cause mortality. Although requiring replication, these new findings add to the potentially harmful association of consuming high quantities of ASB with these health outcomes.

Aged

Arterial Occlusive Diseases - epidemiology

Arterial Occlusive Diseases - mortality

Beverages - adverse effects

Body Mass Index

Brain Ischemia - epidemiology

Brain Ischemia - mortality

Female

Humans

Incidence

Longitudinal Studies

Middle Aged

Mortality - trends

Prospective Studies

Risk Factors

Socioeconomic Factors

Stroke - epidemiology

Stroke - mortality

Sweetening Agents - adverse effects

Women's Health

Details

Title: Subtitle: Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women's Health Initiative
Creators: Yasmin Mossavar-Rahmani - From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Y.M.-R., V.K., S.W.-S.)
Victor Kamensky - From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Y.M.-R., V.K., S.W.-S.)
JoAnn E Manson - Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.)
Brian Silver - Department of Neurology, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (B.S.)
Stephen R Rapp - Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine Winston-Salem, NC (S.R.R.)
Bernhard Haring - Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.H.)
Shirley A A Beresford - School of Public Health, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, WA (S.A.A.B.)
Linda Snetselaar - Department of Epidemiology, College of Public Health, University of Iowa (L.S.)
Sylvia Wassertheil-Smoller - From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Y.M.-R., V.K., S.W.-S.)
Women’s Health Initiative (WHI) investigators
Resource Type: Journal article
Publication Details: Stroke (1970), Vol.50(3), pp.555-562
DOI: 10.1161/STROKEAHA.118.023100
PMID: 30802187
PMCID: PMC6538252
NLM abbreviation: Stroke
ISSN: 0039-2499
eISSN: 1524-4628
Grant note: R01 AG055527 / NIA NIH HHS HHSN268201600018C / NHLBI NIH HHS P30 AG049638 / NIA NIH HHS HHSN268201600003C / NHLBI NIH HHS HHSN268201600004C / NHLBI NIH HHS HHSN268201600002C / NHLBI NIH HHS HHSN268201600001C / NHLBI NIH HHS R01 HL136266 / NHLBI NIH HHS
Language: English
Date published: 03/2019
Academic Unit: Epidemiology; Fraternal Order of Eagles Diabetes Research Center; Internal Medicine
Record Identifier: 9984215143002771

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