Table 2.
Prospective association of added sugars and SSBs with total cardiovascular disease, coronary heart disease, and heart failure among 109,034 participants in the Women’s Health Initiative (CT + OS) (1993–2021).
| Model 1 * | Model 2 ** | Model 3 *** | Model 4 **** | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Cases/ Total |
Person-Years | HR (95% CI) | p-Value | HR (95% CI) | p Value | HR (95% CI) | p-Value | HR (95% CI) | p Value | |
| TOTAL CARDIOVASCULAR DISEASE | ||||||||||
| %EAS | ||||||||||
| <10% | 5057/ 48,537 |
816,087 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| 10-14.9% | 4209/ 39,857 |
669,565 | 1.03 (0.99, 1.07) |
0.18 | 1.01 (0.97, 1.06) |
0.65 | 1.00 (0.96, 1.06) |
0.74 | 1.01 (0.97, 1.06) |
0.62 |
| ≥15.0% | 2331/ 20,640 |
331,972 | 1.18 (1.12, 1.24) |
<0.001 | 1.08 (1.02, 1.14) |
0.01 | 1.08 (1.01, 1.15) |
0.02 | 1.08 (1.01, 1.15) |
0.02 |
| Total SSBs | ||||||||||
| <1/week | 4089/ 37,985 |
635,576 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| 1/week to <1 day | 6713/ 63,957 |
1,068,255 | 1.02 (0.98, 1.07) |
0.25 | 1.00 (0.96, 1.05) |
0.99 | 0.99 (0.95, 1.04) |
0.85 | 1.00 (0.96, 1.05) |
0.91 |
| ≥ 1/day | 795/ 7092 |
113,793 | 1.45 (1.34, 1.56) |
<0.001 | 1.27 (1.17, 1.36) |
<0.001 | 1.30 (1.18, 1.42) |
<0.001 | 1.29 (1.17, 1.42) |
<0.001 |
| Fruit Juices | ||||||||||
| <1/week | 5669/ 52,259 |
864,018 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| ≥1/week | 5928/ 56,775 |
953,607 | 0.98 (0.95, 1.02) |
0.37 | 0.99 (0.94, 1.03) |
0.50 | 0.97 (0.94, 1.02) |
0.33 | 0.99 (0.95, 1.03) |
0.56 |
| Fruit drinks | ||||||||||
| <1/week | 11,020/ 104,126 |
1,742,044 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| ≥1/week | 577/ 4908 |
75,581 | 1.30 (1.19, 1.41) |
<0.001 | 1.14 (1.03, 1.25) |
0.01 | 1.14 (1.03, 1.25) |
<0.001 | 1.13 (1.03, 1.25) |
0.01 |
| Soft drinks | ||||||||||
| <1/week | 9126/ 86,647 |
1,460,115 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| ≥1/week | 2471/ 22,387 |
357,510 | 1.24 (1.18, 1.30) |
<0.001 | 1.11 (1.06, 1.17) |
<0.001 | 1.10 (1.05, 1.17) |
<0.001 | 1.10 (1.04, 1.16) |
<0.001 |
| CORONARY HEART DISEASE | ||||||||||
| %EAS | ||||||||||
| <10% | 2055/ 48,537 |
840,422 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| 10-14.9% | 1657/ 39,857 |
689,954 | 1.00 (0.94, 1.07) |
0.96 | 0.99 (0.23, 1.07) |
0.83 | 1.01 (0.94, 1.09) |
0.77 | 1.02 (0.94, 1.09) |
0.69 |
| ≥15.0% | 983/ 20,640 |
342,816 | 1.22 (1.13, 1.32) |
<0.001 | 1.14 (1.04, 1.24) |
<0.01 | 1.19 (1.08, 1.31) |
<0.001 | 1.20 (1.09, 1.32) |
<0.001 |
| Total SSBs | ||||||||||
| <1/week | 1703/ 37,985 |
654,137 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| 1/week to <1 day | 2670/ 63,957 |
1,101,210 | 0.99 (0.93, 1.05) |
0.72 | 0.96 (0.90, 1.03) |
0.27 | 0.97 (0.90, 1.04) |
0.42 | 0.98 (0.91, 1.05) |
0.52 |
| ≥ 1/day | 322/ 7092 |
117,846 | 1.44 (1.27, 1.63) |
<0.001 | 1.26 (1.10, 1.45) |
<0.001 | 1.34 (1.16, 1.56) |
<0.001 | 1.35 (1.16, 1.57) |
<0.001 |
| Fruit Juices | ||||||||||
| <1/week | 2369/ 52,259 |
889,998 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| ≥1/week | 2326/ 56,775 |
983,195 | 0.93 (0.88, 0.99) |
0.02 | 0.92 (0.86, 0.98) |
0.01 | 0.92 (0.86, 0.99) |
0.02 | 0.93 (0.87, 0.99) |
0.03 |
| Fruit drinks | ||||||||||
| <1/week | 4472/ 104,126 |
1,794,920 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| ≥1/week | 223/ 4908 |
78,273 | 1.24 (1.08, 1.42) |
<0.001 | 0.98 (0.84, 1.15) |
0.85 | 1.00 (0.86, 1.17) |
0.98 | 0.99 (0.85, 1.17) |
0.94 |
| Soft drinks | ||||||||||
| <1/week | 3683/ 86,647 |
1,503,955 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| ≥1/week | 1012/ 22,387 |
369,238 | 1.27 (1.18, 1.37) |
<0.001 | 1.16 (1.07, 1.26) |
<0.001 | 1.17 (1.08, 1.28) |
<0.001 | 1.17 (1.08, 1.27) |
<0.001 |
| HEART FAILURE | ||||||||||
| %EAS | ||||||||||
| <10% | 646/ 48,537 |
848,296 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| 10-14.9% | 496/ 39,857 |
696,141 | 0.96 (0.86, 1.09) |
0.54 | 0.96 (0.84, 1.10) |
0.57 | 0.94 (0.82 1.08) |
0.37 | 0.96 (0.84, 1.10) |
0.56 |
| ≥15.0% | 279/ 20,640 |
364,555 | 1.10 (0.95, 1.27) |
0.19 | 1.02 (0.87, 1.20) |
0.81 | 0.99 (0.83, 1.19) |
0.95 | 1.01 (0.84, 1.20) |
0.94 |
| Total SSBs | ||||||||||
| <1/week | 469/ 37,985 |
661,580 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| 1/week to <1 day | 853/ 63,957 |
1,110,471 | 1.07 (0.95, 1.20) |
0.24 | 1.03 (0.90, 1.17) |
0.70 | 1.01 (0.88, 1.15) |
0.91 | 1.03 (0.90, 1.18) |
0.64 |
| ≥ 1/day | 99/ 7092 |
118,942 | 1.51 (1.21, 1.89) |
<0.001 | 1.32 (1.03 1.69) |
0.03 | 1.33 (1.02, 1.73) |
0.03 | 1.35 (1.03, 1.76) |
0.03 |
| Fruit Juices | ||||||||||
| <1/week | 644/ 52,259 |
899,899 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| ≥1/week | 777/ 56,775 |
991,093 | 1.06 (0.95, 1.18) |
0.29 | 1.07 (0.95, 1.21) |
0.26 | 1.05 (0.93, 1.19) |
0.44 | 1.08 (0.96, 1.22) |
0.22 |
| Fruit drinks | ||||||||||
| <1/week | 1336/ 104,126 |
1,812,274 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| ≥1/week | 85/ 4908 |
78,720 | 1.61 (1.29, 2.01) |
<0.001 | 1.61 (1.29, 2.05) |
<0.001 | 1.64 (1.28, 2.09) |
<0.001 | 1.61 (1.26, 2.06) |
<0.001 |
| Soft drinks | ||||||||||
| <1/week | 1108/ 86,647 |
1,518,384 | 1.00 reference |
1.00 reference |
1.00 reference |
1.00 reference |
||||
| ≥1/week | 313/ 22,387 |
372,609 | 1.32 (1.16, 1.50) |
<0.001 | 1.09 (0.94, 1.27) |
0.26 | 1.09 (0.94, 1.28) |
0.26 | 1.07 (0.92, 1.26) |
0.37 |
Abbreviations: CT = clinical trial; %EAS = percent energy from added sugar; HR = hazard ratio; OS = observational study; SSB = sugar-sweetened beverage. Under/over energy reporters and those with baseline CVD, diabetes, and cancer were excluded from the analysis. Total CVD is a composite of incidence and death from CHD, stroke, heart failure, and coronary revascularization (CABG or PTCA). * Model 1 adjusted for age, region, smoking, and study arm. ** Model 2 adjusted for model 1+ ethnicity, education, marital status, BMI, physical activity, alcohol intake, energy intake, hypertension status, family history of CVD, family history of diabetes, hormone therapy use, and cholesterol-lowering medication use. *** Model 3 adjusted for model 2 + total protein intake, saturated fat intake, trans fat intake, and fiber intake, excluding BMI. **** Model 4 adjusted for model 3 with BMI.