Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women’s Health Initiative | Stroke

Background and Purpose—

We examine the association between self-reported consumption of
artificially sweetened beverages (ASB) and stroke and its subtypes,
coronary heart disease, and all-cause mortality in a cohort of
postmenopausal US women.


The analytic cohort included 81 714 women from the Women’s Health
Initiative Observational Study, a multicenter longitudinal study of the
health of 93 676 postmenopausal women of ages 50 to 79 years at baseline
who enrolled in 1993 to 1998. This prospective study had a mean
follow-up time of 11.9 years (SD of 5.3 years.) Participants who
completed a follow-up visit 3 years after baseline were included in the


Most participants (64.1%) were infrequent consumers (never or <1/week) of
ASB, with only 5.1% consuming ≥2 ASBs/day. In multivariate analyses,
those consuming the highest level of ASB compared to never or rarely
(<1/wk) had significantly greater likelihood of all end points
(except hemorrhagic stroke), after controlling for multiple covariates.
Adjusted models indicated that hazard ratios and 95% confidence
intervals were 1.23 (1.02–1.47) for all stroke; 1.31 (1.06–1.63) for
ischemic stroke; 1.29 (1.11–1.51) for coronary heart disease; and 1.16
(1.07–1.26) for all-cause mortality. In women with no prior history of
cardiovascular disease or diabetes mellitus, high consumption of ASB was
associated with more than a 2-fold increased risk of small artery
occlusion ischemic stroke hazard ratio =2.44 (95% confidence interval,
1.47–4.04.) High consumption of ASBs was associated with significantly
increased risk of ischemic stroke in women with body mass index ≥30;
hazard ratio =2.03 (95% confidence interval, 1.38–2.98).


intake of ASB was associated with increased risk of stroke,
particularly small artery occlusion subtype, coronary heart disease, and
all-cause mortality. Although requiring replication, these new findings
add to the potentially harmful association of consuming high quantities
of ASB with these health outcomes.

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