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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.

Author information

1
From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Y.M.-R., V.K., S.W.-S.).
2
Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.).
3
Department of Neurology, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (B.S.).
4
Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine Winston-Salem, NC (S.R.R.).
5
Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.H.).
6
School of Public Health, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, WA (S.A.A.B.).
7
Department of Epidemiology, College of Public Health, University of Iowa (L.S.).

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.

KEYWORDS:

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

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