Physicians' Academy for Cardiovascular Education

Higher risk for coronary atherosclerosis with increasing soft drink consumption

Chun S et al., Am Heart J 2016

Sugar-sweetened carbonated beverage consumption and coronary artery calcification in asymptomatic men and women

Chun S, Choi Y, Chang Y, et al.
Am Heart J 2016;177:17-24


Sugar-sweetened beverages have been associated with weight gain and type 2 diabetes [1-3]. These beverages have a high energy content and contain many rapidly absorbable carbohydrates. Moreover, high fructose corn syrup, a sweetener used to flavour soft drinks, increased dietary glycaemic load and serum triglyceride levels, and may increase insulin resistance [4,5]. Soft drink consumption is associated with CVD risk [6,7], although the role of soft drink consumption in the development of coronary atherosclerosis is not exactly known yet. Coronary artery calcium (CAC) is a marker of subclinical coronary atherosclerosis [8] as well as a predictor of future coronary heart disease events in a wide range of age groups [9,10].
This study investigated the association of regular soft drink consumption between 2011 and 2013 with the prevalence of subclinical atherosclerosis in 22,210 Korean men and women. Regular soft drinks were defined as sugar-sweetened carbonated beverages and subclinical atherosclerosis was measured by CAC, which was determined by computed tomography (CT). People with missing data, a history of CVD, cancer or diabetes or an extraordinary low or high energy intake were excluded. Dietary consumption was assessed using a 106-item self-administered FFQ, regarding the past year. Participants were categorised as per week no drinks, <1 drink, 1-3 drinks, 3-5 drinks, more than 5 drinks.

Main results

  • Average softdrink consumption was 1.2 drinks per week. 70% of the participants consumed sugar-sweetened carbonated beverages and 5% consumed ≥ 5 per week.
  • The prevalence of detectable CAC was 11.7%.
  • Participants with a higher intake had higher glucose (P = 0.01), insulin (P < 0.001), HOMA-IR (P < 0.001), SBP (P < 0.001), DBP (P < 0.001), total cholesterol (P = 0.002), triglyceride (P < 0.001), LDL-c levels (P < 0.001) and hsCRP (P < 0.001) but lower HDL-c levels (P < 0.001).
  • CAC score ratio for people consuming ≥ 5 sugar-sweetened carbonated beverages per week compared to those who did not consume any of these was 1.86 (95% CI: 1.13-3.07), corrected for age, sex, center and year of screening examination (P trend = 0.04).
  • The CAC score ratio remained significant after adjustment for potential confounders (1.70, 95% CI: 1.03-2.81, P trend = 0.10).
  • The multivariable odds ratio for detectable CAC for people consuming ≥ 5 sugar-sweetened carbonated beverages per week compared to those who did not consume any of these was 1.27 (95% CI: 1.02-1.59).
  • When 6,613 participants were excluded because they did not drink any sugar-sweetened carbonated beverage, the relation with CAC became more evident (multivariable CAC ratio was 1.97, 95% CI: 1.19-3.28).


High sugar-sweetened carbonated beverage consumption was associated with asymptomatic subclinical coronary atherosclerosis in young and middle-aged adults and may therefore be cardiovascular hazard.
Find this article online at Am Heart J


1. Malik VS, Popkin BM, Bray GA, et al. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 2010;33(11):2477-83.
2. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet (London, Engl) 2001;357(9255):505-8.
3. Schulze MB, Manson JE, Ludwig DS, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 2004;292(8):927-34.
4. Schulze MB, Liu S, Rimm EB, et al. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr 2004;80(2):348-56.
5. Stanhope KL, Havel PJ. Endocrine and metabolic effects of consuming beverages sweetened with fructose, glucose, sucrose, or high-fructose corn syrup. Am J Clin Nutr 2008;88(6):1733s-7s.
6. de Koning L, Malik VS, Kellogg MD, et al. Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men. Circulation 2012;125(14):1735-41. [s1].
7. Eshak ES, Iso H, Kokubo Y, et al. Soft drink intake in relation to incident ischemic heart disease, stroke, and stroke subtypes in Japanese men and women: the Japan Public Health Centre–based study cohort I. Am J Clin Nutr 2012;96(6):1390-7.
8. Lee KK, Fortmann SP, Fair JM, et al. Insulin resistance independently predicts the progression of coronary artery calcification. Am Heart J 2009;157(5):939-45.
9. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008;358(13):1336-45.
10. LaMonte MJ, FitzGerald SJ, Church TS, et al. Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women. Am J Epidemiol 2005;162(5):421-9.