Higher Consumption of Sugar-Sweetened Beverages Linked With Greater Coronary Artery Calcium

Consumption of five or more sugar-sweetened carbonated beverages each week was associated with a substantial increased risk for coronary artery calcium (CAC) compared with that seen in people who did not consumer sugar-sweetened beverages, according to a large Korean study. The results indicate that CAC can now be added to a growing list of health conditions linked with sugar-sweetened beverages, such as obesity, heart disease, and type 2 diabetes.

Updated Box. Higher Consumption of Sugar-Sweetened Beverages Linked With Greater Coronary Artery Calcium

Researchers led by Sohyun Chun, MD (Sungkyunkwan University School of Medicine, Seoul, Korea), note that the proportion of people who consumed five or more sugar-sweetened beverages in this Korean population (5.1%) was far less than that seen in many Western populations. Studies have shown, for example, that one-fourth of the US population consumes more than one can of cola a day.

“Sugar-sweetened carbonated beverage consumption has become a major public health and public policy issue,” Chun et al write.

Results from the cross-sectional study were published online April 16, 2016, ahead of print in the American Heart Journal.

Consumption and Risk

Chun and colleagues looked at data on 22,210 adults (median age 40) who underwent comprehensive health screening between 2011 and 2013. Results of a validated food frequency questionnaire showed that 70% of participants consumed sugar-sweetened carbonated beverages, with an average overall weekly consumption of 1.2 drinks.

Using cardiac CT, 11.7% of participants had detectable CAC. Participants who consumed five or more drinks per week had an increased CAC score compared with participants with no consumption of sugar-sweetened drinks. Specifically, when the data were adjusted for age, sex, center, and year of screening exam, participants with the highest consumption had an 86% increased CAC score ratio. Additional adjustment for potential confounders decreased the ratio slightly, but the difference for CAC score between the highest consumption group and the no-consumption group remained significant.

Table. Higher Consumption of Sugar-Sweetened Beverages Linked With Greater Coronary Artery Calcium

In a secondary analysis looking at the presence vs absence of detectable CAC, participants who consumed five or more sugar-sweetened beverages a week were more likely to have detectable CAC compared with participants who did not consume these drinks (OR 1.27; 95 CI 1.02-1.59).

Inconsistent Results

As of 2013, calcium scoring has a minor role in the American College of Cardiology/American Heart Association clinical guideline recommendations for cardiovascular risk assessment.

“Calcium scoring is not recommended as part of routine assessment because it does not add too much more to the risk assessment compared to standard clinical assessment of cardiovascular risk factors,” Paul Schoenhagen, MD (Cleveland Clinic, Cleveland, OH), said in a phone interview with TCTMD. “But, the use of calcium scoring as an indicator of subclinical atherosclerotic changes in the coronary arteries is very established and it is a solid marker of relatively early change and the development of atherosclerosis in the coronary artery.”

Schoenhagen said the discovery of a possible association between sugar-sweetened beverages and CAC is not necessarily a game-changer, but does add one more piece to the puzzle of how these beverages are related to other health issues such as obesity and type 2 diabetes.

He noted, however, that one of the major limitations of the study is the fact that increasing consumption of sugar-sweetened beverages was not consistently associated with increasing risk.

“If you look at the group of patients with moderate consumption of three to five drinks, the number is smaller than in people who did not drink these beverages,” Schoenhagen pointed out. “In other words, in someone with moderate consumption the risk does not seem to be elevated and it is unclear why that is the case.”

Schoenhagen also agreed with the researchers that these results from a Korean population may not be widely generalizable to other populations, particularly Western populations where consumption of these sugar-sweetened beverages is much higher.

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  • Chun S, Choi Y, Chang Y, et al. Sugar-sweetened carbonated beverage consumption and coronary artery calcification in asymptomatic men and women. Am Heart J. 2016;Epub ahead of print.

  • Drs. Chun and Schoenhagen report no relevant conflicts of interest.