Abstract 016: Sugar-Sweetened Beverage Consumption is Inversely Associated with Coronary Flow Reserve among Male Middle-Aged Twins

Abstract

Introduction: Several previous studies have reported a link between sugar-sweetened beverage (SSB) consumption and numerous cardiovascular disease (CVD) risk factors including hypertension, dyslipidemia, and obesity. However, our understanding of how SSB consumption affects cardiovascular function remains limited. We sought to investigate the association between SSB consumption and coronary flow reserve (CFR), a measure of overall coronary vasodilator capacity and microvascular function. Hypothesis: Increased SSB consumption is associated with lower CFR. Methods: A sample of 320 male middle-aged twins, including 128 monozygotic and dizygotic twin pairs and 64 unpaired twins, with no previous history of coronary heart disease (CHD) and diabetes, was recruited from the Vietnam Era Twin Registry. All twins underwent comprehensive cardiovascular assessments and completed the Willett food-frequency questionnaire. Reported intakes of fruit drinks, regular carbonated beverages with sugar, low-calorie carbonated beverages with sugar, and other SSBs were used to derive habitual daily SSB consumption for the previous 12 months. Positron emission tomography [N 13 ] ammonia with quantitation of myocardial blood flow at rest and after adenosine stress was used to measure CFR. Mixed-effect regression analysis was used to examine the association between SSB consumption and CFR both at the individual level and between and within twin pairs. Potential confounders included demographic characteristics, lifestyle factors (including physical activity), traditional CVD risk factors, total energy intake, and other nutritional factors such as intake of cholesterol, fiber, sodium, alcohol, and saturated, monounsaturated, and polyunsaturated fatty acids. Results: The mean age of the twins was 55 years (SD = 3.2) and 94.4% (302 out of 320) were white. Across quintiles of twins consuming less than 2 SSBs per day, 2 to less than 4, 4 to less than 6, 6 to less than 8, and 8 or more, adjusted geometric mean CFR measurements were, respectively, 2.49, 2.45, 2.43, 2.37, and 2.18 ( P = 0.032 for linear trend) with the top quintile having a 12.4% lower CFR than the bottom quintile. The inverse association observed at the individual level persisted between-pairs ( P = 0.042), but was substantially reduced and no longer significant within twin pairs. These associations did not differ by zygosity. Conclusions: SSB consumption is inversely associated with CFR, a measure of coronary microvascular function, independent of traditional CVD risk factors. However, shared familial factors, such as growing up in the same home environment and adopting parental behaviors throughout youth and adolescence, may mediate the association between SSB consumption and CFR. Our study supports the importance of early-life, family-level interventions to promote healthy eating and improve cardiovascular health.