Artificially sweetened drinks may be just as harmful to CV health as sugar-sweetened ones.

Drinking artificially sweetened beverages may be no more heart healthy than consuming soft drinks, syrups or fruit drinks, according to research published in the Journal of the American College of Cardiology.

Findings from the French NutriNet-Santé cohort, launched in 2009, indicated that intake of sugary or artificially sweetened drinks at any volume may be associated with greater risk for incident stroke, transient ischemic attack, MI, ACS and angioplasty, compared with no consumption at all.

“Artificially sweetened beverages are marketed as a healthier alternative, but their cardiometabolic impact is debated,” Eloi Chazelas, PhD candidate at Sorbonne Paris Nord University, France, and colleagues wrote.

“The health effects of non-nutritive sweeteners are currently debated based on conflicting epidemiological results,” the researchers wrote. “Mechanistic data suggest various metabolic impacts of non-nutritive sweeteners, notably through gut microbiota perturbation.”

This analysis included 104,760 individuals (mean age, 43 years) who participated in regularly administered questionnaires examining physical activity, socioeconomic status and anthropometry. Every 6 months, participants filled out three web-based 24-hour dietary records. The primary outcome was incidence of first stroke, TIA, MI, ACS and angioplasty, validated based on medical records.

Participants were classified as either nonconsumers, low consumers or high consumers of sugary or artificially sweetened beverages. Individuals were then stratified by beverage type.

Compared with nonconsumers, investigators found that high consumers of both sugary sweetened (median intake, 185 mL per day; HR = 1.2; 95% CI, 1.04-1.4) and artificially sweetened beverages (median intake, 176.7 mL per day; HR = 1.32; 95% CI, 1-1.73) had greater risk for experiencing any one of the CV outcomes.

“Evidence demonstrating the detrimental impact of sugary drinks on cardiovascular health is accumulating, so we were not surprised by these findings,” Chazelas and Mathilde Touvier, PhD, HDR, director of the Nutritional Epidemiology Research Team at the Center of Research in Epidemiology in Bobigny, France, wrote in an email to Healio. “Regarding artificially sweetened beverages, evidence is less clear and their impact on cardiometabolic health is still debated. The health impact of artificial sweeteners is questioned: Some experimental studies suggest that they may potentially have adverse metabolic effects such as increased adiposity, impaired glucose homeostasis and hyperinsulinemia, as well as alteration of gut microbiota.”

Moreover, less frequent consumers of either sugary sweetened (median intake, 46.7 mL per day; HR = 1.05; 95% CI, 0.92-1.2) or artificially sweetened beverages (median intake, 40 mL per day; HR = 1.15; 95% CI, 0.94-1.42) were at greater risk compared with nonconsumers.

“Higher intakes of sugary drinks and artificially sweetened beverages were associated with a higher risk of CVD, suggesting that artificially sweetened beverages might not be a healthy substitute for sugary drinks,” the researchers wrote. “These data provide additional arguments to fuel the current debate on taxes, labeling, and regulation of sugary drinks and artificially sweetened beverages. To establish a causal link, replication in other large-scale prospective cohorts and mechanistic investigations are needed.”