Sugars and cardiovascular disease research

Resource Type: Research

Current evidence on a direct link between sugars and cardiovascular disease (CVD) is inconclusive. While there appears to be an association between high sugars intake and CVD risk factors such as weight gain and insulin sensitivity, consumption of sugars at normal levels appears to have no effect.


Key research 

Rippe JM & Angelopoulos TJ. (2016). Sugars, obesity, and cardiovascular disease: results from recent randomized control trials. Eur J Nutr, 55:45-53.
This review of randomised trials, systematic reviews and meta-analyses does not support a link between sugar consumption at normal levels and various adverse metabolic and health effects, including those on energy-regulating hormones, obesity, CVD, diabetes, liver fat accumulation and neurologic responses.

Te Morenga LA, Howatson AJ,  Jones RM, et al. (2014). Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am J Clin Nutr, 100(1):65-79.
Higher compared with lower sugar intakes significantly raised triglyceride concentrations, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. There was a stronger association in studies where energy balance was maintained and when no difference in weight change was reported, indicating the effect of high sugar intake on lipids was independent of effects of sugars on body weight. The effect of sugar intake on blood pressure was greatest in trials ≥8 wk in duration.


Other research

Khan TA, Tayyiba M, Agarwal A, et al. (2019). Relation of total sugars, sucrose, fructose, and added sugars with the risk of cardiovascular disease: a systematic review and dose-response meta-analysis of prospective cohort studies. Mayo Clinic Proceedings, 94(12):2399-2414.
Total sugars, sucrose and fructose were not associated with CVD incidence. Total sugars, fructose, and added sugars were associated with increased CVD mortality, with the threshold for harm above intakes of 133 grams (26% energy) for total sugars, 58 grams (11% energy) for fructose, and 65 grams (13% energy) for added sugars. No harmful association with CVD mortality was seen at lower intakes of these sugars or at any dose for sucrose.

Fattore E, Botta F, Agostoni C & Bosetti C. (2017). Effects of free sugars on blood pressure and lipids: a systematic review and meta-analysis of nutritional isoenergetic intervention trials. Am J Clin Nutr, 105(1):42–56.
In short- or moderate-term isoenergetic intervention trials, the substitution of free sugars for complex carbohydrates had no effect on blood pressure or body weight, and an unclear effect on blood lipid profile. 

Yang Q, Zhang Z, Gregg EW, et al. (2014). Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med, 174(4):516-524.
Among US adults, the adjusted mean percentage of daily calories from added sugar increased from 15.7% in 1988-1994 to 16.8% in 1999-2004, and decreased to 14.9% in 2005-2010. Most adults consumed 10% or more of calories from added sugar and approximately 10% consumed 25% or more in 2005-2010. The risk of CVD mortality increased exponentially with increasing usual percentage of calories from added sugar, with the relative risk more than double for those who consumed 21% or more of calories from added sugar.

Chiavaroli L, de Souza RJ, Ha V, et al. (2015). Effect of fructose on established lipid targets: A systematic review and meta-analysis of controlled feeding trials. J Am Heart Assoc, 4(9).
Fructose only had an adverse effect on established lipid targets when added to existing diets so as to provide excess calories (+21% to 35% energy). When isocalorically exchanged for other carbohydrates, fructose had no adverse effects on blood lipids.

Sieri S, Agnoli C, Grioni S, et al. (2020). Glycemic index, glycemic load, and risk of coronary heart disease: a pan-European cohort study. Am J Clin Nutr, nqaa157.
High dietary glycemic load (GL) was significantly associated with increased coronary heart disease (CHD) risk in overweight and obese persons, but not in those of normal weight. High dietary glycemic index (GI) was only inconsistently associated with CHD risk. High consumption of available carbohydrate (e.g. white rice and refined wheat) and added sugars (mainly from SSBs), but not starch, was associated with greater CHD risk.

Loader J, Meziat C, Watts R, et al. (2017). Effects of sugar-sweetened beverage consumption on microvascular and macrovascular function in a healthy Population. Arterioscler Thromb Vasc Biol, 37(6):1250-1260.
Compared to water, acute hyperglycemia from SSB consumption impaired microvascular and macrovascular function, while vascular smooth muscle was preserved. To the authors’ knowledge, this is the first study to demonstrate the effects of acute hyperglycemia from SSB alone on vascular function.

Cheungpasitporn W, Thongprayoon C, Edmonds PJ, et al. (2015). Sugar and artificially sweetened soda consumption linked to hypertension: A systematic review and meta-analysis. Clin Exp Hypertens, 37(7):587-93.
This meta-analysis showed a significant association between both sugar-sweetened and artificially-sweetened soda consumption and hypertension, in both males and females. There was an overall 12% and 15% increased risk of hypertension for sugar-sweetened soda and artificially sweetened soda consumption, respectively.

West S, Smail O & Bond B. (2019). The acute influence of sucrose consumption with and without vitamin C co-ingestion on microvascular reactivity in healthy young adults. Microvasc Res, 126:103906.
The consumption of a sugar load representative of commercially available SSBs did not influence microvascular reactivity. The co-ingestion of Vitamin C also failed to influence microvascular reactivity, but did increase the rate of oxygen extraction.


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