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Stroke. 2019 Mar;50(3):555-562. doi: 10.1161/STROKEAHA.118.023100.

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

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From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Y.M.-R., V.K., S.W.-S.).
Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.).
Department of Neurology, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (B.S.).
Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine Winston-Salem, NC (S.R.R.).
Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.H.).
School of Public Health, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, WA (S.A.A.B.).
Department of Epidemiology, College of Public Health, University of Iowa (L.S.).


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.


brain ischemia; coronary heart disease; diabetes mellitus; stroke; sweetening agents

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