Study Says Sugar-Sweetened Beverages Increase Heart Disease Risk in Men

A study based on 42,883 men enrolled in the Health Professionals Follow-up Study has allegedly determined that those who drank one 12 ounce sugar-sweetened beverage (SSB) per day increased their coronary heart disease (CHD) risk by 20 percent over those who did not drink any SSBs. Lawrence de Koning, et al., “Sweetened Beverage Consumption, Incident Coronary Heart Disease and Biomarkers of Risk in Men,” Circulation, March 2012. Led by Harvard School of Public Health researchers Lawrence de Koning and Frank Hu, the study, which reported 3,683 CHD cases over 22 years of follow-up, concluded that participants “in the top quartile of sugar-sweetened beverage intake had a 20 percent higher relative risk of CHD than those in the bottom quartile” while also exhibiting “some adverse changes in lipids, inflammatory factors, and leptin.”

“This study adds to the growing evidence that sugary beverages are detrimental
to cardiovascular health. Certainly, it provides strong justification
for reducing sugary beverage consumption among patients, and more
importantly, in the general population,” said Hu in a March 12, 2012, American
Heart Association press release, which noted that these recent results parallel
analysis of the 2009 Nurses’ Health Study involving women. These similarities
also sparked commentary by Northwestern University Feinberg School of
Medicine Assistant Professor Mark Huffman, whose concurrent Circulation
article attempts to further contextualize the study using the late biostatistician
Austin Bradford Hill’s criteria to assess whether the associations between
SSBs and CHD are causal or not.

As Huffman notes, “Bradford Hill’s research legacy lay in the association between tobacco and lung cancer, which had a relative risk nine to ten times higher in smokers compared to non-smokers.” The article thus reviews de Koning and Hu’s work according to the Bradford Hill criteria used to establish evidence of causation, that is, (i) strength of association; (ii) consistency; (iii) specificity; (iv) temporality; (v) biological gradient; (vi) plausibility; (vii) coherence; (viii) experiment (reversibility); and (ix) analogy. Although Huffman ultimately finds that the association described in the study meets some of these criteria and appears “sufficiently strong to be considered causal,” he cautions that “the question remains as to whether there is something specific about SSBs that leads to CHD or if residual confounding exists.”

“Few would argue that SSB consumption should not decrease, particularly
given high consumption rates and the current obesity epidemic, and de
Koning and colleagues’ findings are a provocative page in the evolving story
of SSBs and CHD,” concludes Huffman. “As additional research explores this
relationship, the Bradford Hill criteria may be useful guideposts in placing
future results into context.”