Sugar consumption and major cardiovascular events: Systematic review
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cardiovascular diseases
myocardial infarction

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Sierra Umaña, S. F., Garcés Arias, A. ., Salinas Mendoza, S. ., Castillo Rodriguez, C. A. ., & Álzate Granados, J. P. (2022). Sugar consumption and major cardiovascular events: Systematic review. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 9(4).


Context: Unhealthy dietary factors have been associated with increased cardiovascular risk, one of them; sugar consumption.

Objective: Search, evaluation and analysis of the best available evidence on sugar consumption and major cardiovascular outcomes.

Methods: Systematic review of the literature. Quantitative evaluation between sugar consumption and one of these major cardiovascular events (cardiovascular death, acute non-fatal myocardial infarction or non-fatal stroke). Participants older than 18 years were included no pregnant and no congenic cardiac disease. 

Results: We included 31 primary studies (27 cohort studies and 4 case-control studies). Twenty-one evaluated the consumption of sugar and acute myocardial infarction, 12 consumption of sugar and stroke and 6 consumptions of sugar and cardiovascular death. For the 3 outcomes the results were controversial, however, with statistical significance in several studies for the association in question, when evaluating sugar consumption by glycemic load, glycemic index, total carbohydrates, among others.

Conclusion: Although evidence is controversial, it consistently suggests according cohort studies mainly that carbohydrates with high glycemic index, added sugars and sugary drinks, increase the risk of presenting major cardiovascular adverse events such as acute myocardial infarction, stroke and cardiovascular death.
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Defunciones No Fetales 2017. [Internet]. [cited 2018 Feb 3]. Available from:

Fullman N, Barber RM, Abajobir AA, Abate KH, Abbafati C, Abbas KM, et al. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet. 2017 Sep;390(10100):1423–59. DOI: 10.1016/S0140-6736(17)32336-X

Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016 Aug;37(29):2315–81. DOI: 10.1093/eurheartj/ehw106

The Lancet. Life, death, and disability in 2016. Lancet. 2017 Sep;390(10100):1083. DOI:

Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, et al. Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries. N Engl J Med. 2014 Aug;371(9):818–27. DOI:

Johnson RK, Appel LJ, Brands M, Howard B V., Lefevre M, Lustig RH, et al. Dietary Sugars Intake and Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation. 2009 Sep;120(11):1011–20. DOI: 10.1161/CIRCULATIONAHA.109.192627

American Diabetes Association AD. 4. Lifestyle Management: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan;41(Suppl 1):S38–50. DOI: 10.23371/dc18-S004

Committee DGA, HHS O of DP and HP (U. S)., USDA C for NPP (U. S)., (U.S.) H and HSD. Dietary Guidelines for Americans 2015-2020. ISBN: 9780160934650

Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, et al. American association of clinical endocrinologists and american college of endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract. 2017 Apr;23(Supplement 2):1–87. DOI: 10.4158/EP171764.APPGL

Reiner Z, Catapano AL, De Backer G, Graham I, Taskinen M-R, Wiklund O, et al. ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J. 2011 Jul;32(14):1769–818. DOI: 10.1093/eurheartj/ehr158

Liu S, Manson JE, Stampfer MJ, Holmes MD, Hu FB, Hankinson SE, et al. Dietary glycemic load assessed by food-frequency questionnaire in relation to plasma high-density-lipoprotein cholesterol and fasting plasma triacylglycerols in postmenopausal women. Am J Clin Nutr. 2001 Mar;73(3):560–6. ISSN: 0002-9165 DOI: 10.4158/EP161365.GL

Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American association of clinical endocrinologists and American college of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016 Jul;22(Supplement 3):1–203. DOI: 10.4158/EP161365.GL

Dehghan M, Mente A, Zhang X, Swaminathan S, Li W, Mohan V, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet (London, England). 2017 Nov;390(10107):2050–62. DOI: 10.1016/S0140-6736(17)32252-3

Micha R, Peñalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States. JAMA. 2017 Mar;317(9):912. DOI: 10.1001/jama.2017.0947

Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1.0. [updated March 2011]. The Cochrane Collaboration, 2011 Avialable from Vol. 4, The Cochrane Collaboration. 2014. ISBN: 9780470057964

Checklists and notes. Health care improvement Scotland. Checklists (

Yu D, Shu X-O, Li H, Xiang Y-B, Yang G, Gao Y-T, et al. Dietary Carbohydrates, Refined Grains, Glycemic Load, and Risk of Coronary Heart Disease in Chinese Adults. Am J Epidemiol. 2013 Nov;178(10):1542–9. DOI: 10.1093/aje/kwt178

Levitan EB, Mittleman MA, Wolk A. Dietary glycaemic index, dietary glycaemic load and incidence of myocardial infarction in women. Br J Nutr. 2010 Apr;103(07):1049. DOI: 10.1017/S0007114509992674

van Dam RM, Visscher AW, Feskens EJ, Verhoef P, Kromhout D. Dietary glycemic index in relation to metabolic risk factors and incidence of coronary heart disease: the Zutphen Elderly Study. Eur J Clin Nutr. 2000 Sep;54(9):726–31. DOI: 10.1038/sj.ejcn.1601086

Levitan EB, Mittleman MA, Håkansson N, Wolk A. Dietary glycemic index, dietary glycemic load, and cardiovascular disease in middle-aged and older Swedish men. Am J Clin Nutr. 2007 Jun;85(6):1521–6. DOI: 10.1093/ajcn/85.6.1521

Oba S, Nagata C, Nakamura K, Fujii K, Kawachi T, Takatsuka N, et al. Dietary glycemic index, glycemic load, and intake of carbohydrate and rice in relation to risk of mortality from stroke and its subtypes in Japanese men and women. Metabolism. 2010 Nov;59(11):1574–82. DOI: 10.1016/j.metabol.2010.02.004

Yu D, Zhang X, Shu X-O, Cai H, Li H, Ding D, et al. Dietary glycemic index, glycemic load, and refined carbohydrates are associated with risk of stroke: a prospective cohort study in urban Chinese women. Am J Clin Nutr. 2016 Nov;104(5):1345–51. DOI: 10.3945/ajcn.115.129379

Sieri S, Brighenti F, Agnoli C, Grioni S, Masala G, Bendinelli B, et al. Dietary glycemic load and glycemic index and risk of cerebrovascular disease in the EPICOR cohort. PLoS One. 2013;8(5):e62625. DOI: 10.1371/journal.pone.0062625

Burger KNJ, Beulens JWJ, Boer JMA, Spijkerman AMW, van der A DL. Dietary Glycemic Load and Glycemic Index and Risk of Coronary Heart Disease and Stroke in Dutch Men and Women: The EPIC-MORGEN Study. Schäfer A, editor. PLoS One. 2011 Oct;6(10):e25955. DOI: 10.1371/journal.pone.0025955

Sieri S, Krogh V, Berrino F, Evangelista A, Agnoli C, Brighenti F, et al. Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort. Arch Intern Med. 2010 Apr;170(7):640–7. DOI: 10.1001/archinternmed.2010.15

Kaushik S, Wang JJ, Wong TY, Flood V, Barclay A, Brand-Miller J, et al. Glycemic Index, Retinal Vascular Caliber, and Stroke Mortality. Stroke. 2009 Jan;40(1):206–12. DOI: 10.1161/STROKEAHA.108.513812

Beulens JWJ, de Bruijne LM, Stolk RP, Peeters PHM, Bots ML, Grobbee DE, et al. High Dietary Glycemic Load and Glycemic Index Increase Risk of Cardiovascular Disease Among Middle-Aged Women. J Am Coll Cardiol. 2007 Jul;50(1):14–21. DOI: 10.1016/j.jacc.2007.02.068

Jakobsen MU, Dethlefsen C, Joensen AM, Stegger J, Tjønneland A, Schmidt EB, et al. Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index. Am J Clin Nutr. 2010 Jun;91(6):1764–8. DOI: 10.3945/ajcn.2009.29099

Joshipura KJ, Hung H-C, Li TY, Hu FB, Rimm EB, Stampfer MJ, et al. Intakes of fruits, vegetables and carbohydrate and the risk of CVD. Public Health Nutr. 2009 Jan;12(01):115. DOI: 10.1017/S1368980008002036

Bahadoran Z, Mirmiran P, Tohidi M, Azizi F. Longitudinal Associations of High-Fructose Diet with Cardiovascular Events and Potential Risk Factors: Tehran Lipid and Glucose Study. Nutrients. 2017 Aug;9(8). DOI: 10.3390/nu9080872

Halton TL, Willett WC, Liu S, Manson JE, Albert CM, Rexrode K, et al. Low-Carbohydrate-Diet Score and the Risk of Coronary Heart Disease in Women. N Engl J Med. 2006 Nov;355(19):1991–2002. DOI: 10.1056/NEJMoa055317

Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults. JAMA Intern Med. 2014 Apr;174(4):516. DOI: 10.1001/jamainternmed.2013.13563

Warfa K, Drake I, Wallström P, Engström G, Sonestedt E. Association between sucrose intake and acute coronary event risk and effect modification by lifestyle factors: Malmö Diet and Cancer Cohort Study. Br J Nutr. 2016 Nov;116(09):1611–20. DOI: 10.1017/S0007114516003561

Hardy DS, Hoelscher DM, Aragaki C, Stevens J, Steffen LM, Pankow JS, et al. Association of Glycemic Index and Glycemic Load With Risk of Incident Coronary Heart Disease Among Whites and African Americans With and Without Type 2 Diabetes: The Atherosclerosis Risk in Communities Study. Ann Epidemiol. 2010 Aug;20(8):610–6. DOI: 10.1016/j.annepidem.2010.05.008

de Koning L, Malik VS, Kellogg MD, Rimm EB, Willett WC, Hu FB. Sweetened Beverage Consumption, Incident Coronary Heart Disease, and Biomarkers of Risk in Men. Circulation. 2012 Apr;125(14):1735–41. DOI: 10.1161/CIRCULATIONAHA.111.067017

Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr. 2009 Apr;89(4):1037–42. DOI: 10.3945/ajcn.2008.27140

Pase MP, Himali JJ, Beiser AS, Aparicio HJ, Satizabal CL, Vasan RS, et al. Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia. Stroke. 2017 Apr;STROKEAHA.116.016027. DOI: 10.1161/STROKEAHA.116.016027

Sonestedt E, Hellstrand S, Schulz C-A, Wallström P, Drake I, Ericson U, et al. The Association between Carbohydrate-Rich Foods and Risk of Cardiovascular Disease Is Not Modified by Genetic Susceptibility to Dyslipidemia as Determined by 80 Validated Variants. Müller M, editor. PLoS One. 2015 Apr;10(4):e0126104. DOI: 10.1371/journal.pone.0126104

Li Y, Hruby A, Bernstein AM, Ley SH, Wang DD, Chiuve SE, et al. Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study. J Am Coll Cardiol. 2015 Oct;66(14):1538–48. DOI: 10.1016/j.jacc.2015.07.055

Bernstein AM, de Koning L, Flint AJ, Rexrode KM, Willett WC. Soda consumption and the risk of stroke in men and women. Am J Clin Nutr. 2012 May;95(5):1190–9. DOI: 10.3945/ajcn.111.030205

Shikany JM, Safford MM, Newby PK, Durant RW, Brown TM, Judd SE. Southern Dietary Pattern Is Associated With Hazard of Acute Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Circulation. 2015 Sep;132(9):804–14. DOI: 10.1161/CIRCULATIONAHA.114.014421

Oh K, Hu FB, Cho E, Rexrode KM, Stampfer MJ, Manson JE, et al. Carbohydrate Intake, Glycemic Index, Glycemic Load, and Dietary Fiber in Relation to Risk of Stroke in Women. Am J Epidemiol. 2005 Jan;161(2):161–9. DOI: 10.1093/aje/kwi026

Tavani A, Bosetti C, Negri E, Augustin LS, Jenkins DJA, La Vecchia C. Carbohydrates, dietary glycaemic load and glycaemic index, and risk of acute myocardial infarction. Heart. 2003 Jul;89(7):722–6. DOI: 10.1136/heart.89.7.722

Rodríguez-Campello A, Jiménez-Conde J, Ois Á, Cuadrado-Godia E, Giralt-Steinhauer E, Schroeder H, et al. Dietary Habits in Patients with Ischemic Stroke: A Case-Control Study. Arumugam T V., editor. PLoS One. 2014 Dec;9(12):e114716. DOI: 10.1371/journal.pone.0114716

Saadatnia M, Shakeri F, Hassanzadeh Keshteli A, Saneei P, Esmaillzadeh A. Dietary Patterns in Relation to Stroke among Iranians: A Case-Control Study. J Am Coll Nutr. 2015 Jan;34(1):32–41. DOI: 10.1080/07315724.2014.890553

Guo J, Li W, Wang Y, Chen T, Teo K, Liu L, et al. Influence of dietary patterns on the risk of acute myocardial infarction in China population: the INTERHEART China study. Chin Med J (Engl). 2013 Feb;126(3):464–70. ISSN: 0366-6999

Nishida C, Uauy R, Kumanyika S, Shetty P. The joint WHO/FAO expert consultation on diet, nutrition and the prevention of chronic diseases: process, product and policy implications. Public Health Nutr. 2004 Feb;7(1A):245–50. DOI: 10.1079/phn2003592

Hu FB, Malik VS. Sugar-sweetened beverages and risk of obesity and type 2 diabetes: Epidemiologic evidence. Physiol Behav. 2010 Apr;100(1):47–54. DOI: 10.1016/j.physbeh.2010.01.036

Welsh JA, Sharma A, Abramson JL, Vaccarino V, Gillespie C, Vos MB. Caloric Sweetener Consumption and Dyslipidemia Among US Adults. JAMA. 2010 Apr;303(15):1490. DOI: 10.1001/jama.2010.449

Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, et al. Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle-Aged Women. JAMA. 2004 Aug;292(8):927. DOI: 10.1001/jama.292.8.927

Malik VS, Popkin BM, Bray GA, Després J-P, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010 Mar;121(11):1356–64. DOI: 10.1161/CIRCULATIONAHA.109.876185

Welsh JA, Sharma A, Cunningham SA, Vos MB. Consumption of added sugars and indicators of cardiovascular disease risk among US adolescents. Circulation. 2011 Jan;123(3):249–57. DOI: 10.1161/CIRCULATIONAHA.110.972166

Brown IJ, Stamler J, Van Horn L, Robertson CE, Chan Q, Dyer AR, et al. Sugar-Sweetened Beverage, Sugar Intake of Individuals, and Their Blood Pressure: International Study of Macro/Micronutrients and Blood Pressure. Hypertension. 2011 Apr;57(4):695–701. DOI: 10.1161/HYPERTENSIONAHA.110.165456

Te Morenga LA, Howatson AJ, Jones RM, Mann J. 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. 2014 Jul;100(1):65–79. DOI: 10.3945/ajcn.113.081521

Brownell KD, Farley T, Willett WC, Popkin BM, Chaloupka FJ, Thompson JW, et al. The public health and economic benefits of taxing sugar-sweetened beverages. N Engl J Med. 2009 Oct;361(16):1599–605. DOI: 10.1056/NEJMhpr0905723

De Castro JM. The effects of the spontaneous ingestion of particular foods or beverages on the meal pattern and overall nutrient intake of humans. Physiol Behav. 1993 Jun;53(6):1133–44. DOI: 10.1016/0031-9384(93)90370-u

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