Sugar-Sweetened Beverage Intake and CVD Risk

Quick Takes

  • In this large prospective cohort, sugar-sweetened beverages were associated with an independent, increased risk for CVD including stroke among women.
  • These data suggest that reducing or eliminating sugar-sweetened beverages should be included in lifestyle advice for the prevention of CVD.

Study Questions:

Is sugar-sweetened beverage intake associated with incident cardiovascular disease (CVD)?


The California Teachers Study is an ongoing prospective cohort study of 133,477 active or retired female teachers and administrators. Participants completed mailed questionnaires at study enrollment (1995-1996). Participants were followed up annually. For the present study, 106,178 participants without clinical CVD, diabetes mellitus, or missing data were included. Sugar-sweetened beverages were defined as caloric soft drinks, sweetened bottled waters or teas, and fruit drinks. Information on sugar-sweetened beverages and other dietary factors were collected through a self-administered food frequency questionnaire. CVD endpoints were assessed through linkage with the statewide inpatient hospitalization records (Office of Statewide Health Planning and Development). The primary outcome of interest was incident CVD.


A total of 106,178 women (average age 52.1 ± 13.4 years) were included in the present analysis. Among all participants, 4.2% were daily consumers of sugar-sweetened beverages, whereas 40.9% of participants reported rarely/never consuming sugar-sweetened beverages. During the 20 years of follow-up, 8,848 incident cases of CVD were identified, including 2,677 incident cases of myocardial infarction (MI), 2,889 incident cases of revascularization, and 5,258 incident cases of stroke. After adjusting for potential confounders, women who reported consuming ≥1 serving per day of sugar-sweetened beverages compared with rare/never consumers had a higher risk for CVD (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.06-1.34). An increased risk was also observed for revascularization (HR, 1.26; 95% CI, 1.04-1.54), and stroke (HR, 1.21; 95% CI, 1.04-1.41), but not for MI (HR, 1.18; 95% CI, 0.95-1.47). A higher risk of CVD was also observed for women who consumed ≥1 serving per day of fruit drinks (HR, 1.42; 95% CI, 1.00-2.01; p for trend = 0.021) and caloric soft drinks (HR, 1.23; 95% CI, 1.05-1.44; p for trend = 0.0002), compared with rare/never consumers.


The investigators concluded that consuming ≥1 serving per day of sugar-sweetened beverages was associated with CVD, revascularization, and stroke. Sugar-sweetened beverage intake might be a modifiable dietary target to reduce the risk of CVD among women.


These data support the recommendation for reducing or eliminating sugary beverages. Providers are recommended to advise women to reduce sugar-sweetened drinks as part of primary prevention management.

Keywords: Beverages, Carbonated Beverages, Cardiovascular Diseases, Diet, Drinking Water, Fruit, Inpatients, Myocardial Infarction, Myocardial Revascularization, Primary Prevention, Stroke, Sugar Alcohols, Sweetening Agents, Vascular Diseases

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