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It didn't take very much soft drink consumption for people to see elevated risk of cardiovascular disease (CVD), a large cohort study in France suggested.

People who drank the most sugary drinks (a median 185 ml or 6.26 fl oz per day -- barely half a can of ordinary soda) were more likely to experience a CVD event compared with non-consumers of these drinks (HR 1.20, 95% CI 1.04-1.40), according to a group led by Eloi Chazelas, a PhD candidate at Sorbonne Paris Nord University.

Similarly, those who drank relatively more artificially sweetened beverages (176.7 ml or 5.97 fl oz per day) had higher CVD risk over a median 6.6 years of follow-up compared with non-consumers of the drinks (HR 1.32, 95% CI 1.00-1.73), the investigators reported in a research letter online in the .

The statistics reflected adjustment for other dietary habits, including consumption of alcohol, red and processed meats, whole grains, legumes, and fruits and vegetables, as well as overall calorie counts and comorbidities such as hypertension and type 2 diabetes.

The data suggest that artificially sweetened beverages may not be a healthy substitute for sugary drinks containing 5% or more sugar, Chazelas and colleagues concluded, noting the current debate on taxes, labeling, and regulation of both types of drinks.

The researchers noted that sugar substitutes are thought to have various metabolic effects, including gut microbiota perturbation.

For the study, the team counted first incident cases of stroke, transient ischemic attack, myocardial infarction, acute coronary syndrome, and angioplasty in the CVD endpoint.

At lower intake levels, neither sugary drinks (median 46.7 ml or 1.58 fl oz per day; HR 1.05, 95% CI 0.92-1.20) nor artificially sweetened drinks (40.0 ml or 1.35 fl oz per day; HR 1.15, 95% CI 0.94-1.42) showed a link to CVD.

The study was based on the French cohort launched in 2009. The 104,760 people who volunteered had been asked to complete 24-hour dietary records every 6 months. The investigators linked their files to records from the French national health insurance system and the French national mortality registry.

Study participants had a mean age of 42.9 years, and 78.6% were women. Average body mass index was 23.7, and 17.2% of people were current smokers at baseline. Nearly one in three had a family history of CVD. The prevalence of type 2 diabetes was 1.4%, of high cholesterol was 8.0%, of hypertension was 8.2%, and of hypertriglyceridemia was 1.4%.

The researchers collected an average 5.7 dietary records per person over follow-up.

Study limitations, Chazelas and co-authors said, included potential residual confounding despite the adjustments for covariates. They attempted to account for reverse causality by excluding CVD events in the first 3 years of follow-up. Establishing a causal relationship between sugar substitutes and CVD will require replication in other large-scale prospective cohorts and further mechanistic investigation, the team added.

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