Physicians' Academy for Cardiovascular Education

Artificially sweetened beverages associated with risk of stroke and dementia

Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia

A Prospective Cohort Study

Pase MP, Himali JJ, Beiser AS, et al. - Stroke. 2017; published online ahead of print

Background

Sugar- and artificially sweetened beverages may be associated with an increased risk of stroke and dementia [1-4]. In this study, the association between sugar- or artificially sweetened soft drinks and the 10-year risk of incident stroke and dementia was evaluated using prospective data from the Framingham Offspring Cohort (n=3029 completed exam between 1998-2001).

Main results

Conclusion

Artificially sweetened soft drink consumption was associated with an increased 10-year risk of stroke and dementia in prospective data from the Framingham Offspring Cohort, whereas no such association was identified with sugar-sweetened beverages.

Editorial comment

In their editorial article [5], Wersching, Gardener, and Sacco note that the fact that the intake of sugar-sweetened beverages was not associated with stroke or dementia could be due to selection bias, because participants with a high and long-term consumption of such products may have had a very high cardiovascular risk and died earlier. On the other hand, they explore the possibility of reverse causation leading to the association between artificially sweetened beverages and stroke and dementia, since participants at increased risk of vascular events may switch from sugary to diet beverages, with the objective to control their risk factors.

The authors conclude as follows: ‘The work by Pase et al highly encourages further discussion and more research into this question, for even small causal effects would have tremendous effects on public health due to the popularity of both artificial-sweetened beverages and sugar-sweetened consumption. The current body of literature is inconclusive about the causal nature of the associations between artificial-sweetened beverage consumption and risk of stroke, dementia, diabetes mellitus and the metabolic syndrome. The growing number of epidemiological studies showing strong associations between frequent consumption of artificial-sweetened beverages and vascular outcomes, however, suggests that it may not be reasonable to substitute or promote artificial-sweetened beverages as healthier alternatives to sugar-sweetened beverages. Both sugar-sweetened and artificially sweetened soft drinks may be hard on the brain.’

References

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