Researchers wanted to delve deeper into the association between different cardiovascular diseases and sources of added sugar.

The researchers included data from the Swedish Mammography Cohort and the Cohort of Swedish Men, ultimately including data from 69,705 participants. They excluded participants with cancer, diabetes, or prevalent cardiovascular disease at baseline. They also excluded participants who had extreme intakes because these reports could be inaccurate.

The researchers collected dietary data from 1997 and again from 2009. They estimated how much added sugar participants were consuming and how much this contributed to overall energy intake. They looked at three broad groups of added sugar sources:

1. Sweet treats, such as ice cream and pastries
2. Toppings, such as table sugar and honey
3. Sweetened beverages, such as sodas and fruit drinks (excluding pure fruit juice)

The 2009 dietary questionnaire distinguished between beverages sweetened by sugar and those containing artificial sweeteners.

The researchers looked at several cardiovascular health outcomes among participants: stroke, heart attack, heart failure, aortic stenosis, atrial fibrillation, and abdominal aortic aneurysm. They followed participants through the diagnosis of cardiovascular disease, death, or to the end of 2019.

Throughout follow-up, 25,739 participants received at least one cardiovascular disease diagnosis.

The researchers used several different models that adjusted for various covariates in their analysis. Covariates included components like age, sex, smoking status, exercise levels, and body mass index.

The study does have some limitations that warrant further investigation.

First, the data was explicitly from participants in Sweden, limiting the findings’ generalizability. The cohorts also had lower added sugar intakes than the general Swedish population.

Second, participants self-reported components like dietary data, and these reports may not be accurate. Only 42,327 participants completed the 2009 dietary assessment, limiting the data. It was observational, so it cannot establish cause.

The researchers’ methods of data collection could mean that some data was missed. They also had to operate on certain assumptions, such as that participants with missing data on certain foods did not consume those foods. They also estimated components like total added sugar intake, which could be subject to errors. Researchers also acknowledge that things like confounding and misreporting were possible and could have affected the results. They didn’t estimate dietary sodium intake or account for social networks, which could have affected the results. There was also a danger of chance findings.

The finding that sugar-added beverages did not appear to increase the risk of cardiovascular diseases could be explained by the low number of participants consuming at least one serving a week, limiting researchers’ ability to assess this area. Researchers also note that the relationship between cardiovascular disease risk and artificial sweeteners could have been impacted by reverse causality.

The researchers acknowledge that cardiovascular disease risk factors like high blood pressure and their relationship to added sugar could explain some of the observed associations they found.

Participants were also between the ages of 45 and 83, so it may be helpful to look at data in other age demographics in the future.

The work received funding from several sources, including the Swedish Research Council and the Heart and Lung Foundation.

Janzi noted the following components that may have affected the results:

“In Swedish culture, “fika” is a significant social tradition where people gather with friends, family, or coworkers for coffee and pastries. This practice is so ingrained in Swedish society that many workplaces have scheduled “fika breaks” daily. It’s possible that the consumption of treats during these social interactions is strongly linked to social relationships, which have previously been linked to cardiovascular health. This could mean that those who don’t eat any treats might not have as many of these social interactions. It is also possible that some people avoid consuming treats due to preexisting health concerns, which be what increases the risk of cardiovascular disease.”

Overall, the data implies that higher consumption of sweetened beverages is potentially harmful but that there is more complexity to sugar consumption than meets the eye. More research is required to confirm the results and understand their meaning.

Robert L. Salazar, MD, Interventional Cardiologist, Memorial Hermann, who was not involved in the study, noted the following to Medical News Today:

“This study can help inform how we counsel patients about healthy eating habits and lifestyle modifications. In particular, sweetened beverage consumption should be minimized to improve cardiovascular health and avoid negative outcomes including abdominal aortic aneurysm, ischemic stroke, heart attacks, heart failure and atrial fibrillation.”

“[T]he findings suggest that added sugar intake overall does not have to be completely eliminated for optimal health and that low-moderate and moderate intake may be healthy depending on the source of added sugar.”
— Robert L. Salazar, MD

Janzi noted the following regarding future research:

“Further research is necessary to understand the mechanisms behind the associations between added sugar intake and specific cardiovascular diseases. For example, there are no known biological mechanisms to explain why treats might be linked to a lower risk of cardiovascular disease, and we believe the explanation might lie in the context of treats consumption rather than the treats themselves.”