Abstract P240: Sugar-Sweetened Beverage Intake and Cardiovascular Disease Risk in the California Teachers Study

Abstract

Introduction: Previous observational studies have shown a positive association between sugar-sweetened beverage (SSB) consumption and cardiovascular disease (CVD) risk, but many have been relatively short-term. Objective: To determine the association of SSB consumption over a 20-year period and incident CVD in a large prospective cohort of middle-aged women. Methods: Data are from the California Teachers Study, a US based longitudinal cohort comprised of 133,477 female teachers and administrators who were active or recently retired members of the California State Teachers Retirement System in 1995. After excluding those with a history of CVD and type 2 diabetes mellitus at baseline, our analytic sample was 107,905. SSB consumption constituted regular soft drinks, sweetened bottled waters and teas, and fruit drinks (other than fruit juice) and was derived from a self-administered Block95 food frequency questionnaire. SSB consumption was divided into four categories: Rare or never, >rare/never to <1 serving per week, ≥1 serving per week to <1 serving per day, and ≥1 serving per day. CVD endpoints were based on annual linkage with statewide hospitalization records, defined as first occurrence of myocardial infarction, coronary artery bypass grafting (CABG) or stroke following the International Statistical Classification of Diseases 9 th and 10 th Revision coding system. Cox proportional hazards models were used to assess the association between SSB consumption and incident CVD, after adjusting for potential confounders and mediators. Results: Of a total of 8,946 CVD incident cases over 20 years, the majority were strokes (5,728). In an age-adjusted model, we observed increased hazard ratios (HR) for CVD (HR 1.24 [95% CI 1.11, 1.38]), CABG (HR 1.39 [95% CI 1.13, 1.71]), and stroke (HR 1.21 [95% CI 1.05, 1.39]) events in women who consumed ≥1 serving/day vs those who rarely/never consumed SSBs. Our fully adjusted model included age, smoking, alcohol intake, physical activity, multivitamin and aspirin use, menopausal status, hormone replacement therapy, oral contraceptive use, history of hypertension, body mass index, fruit and vegetable intake, and total energy intake. This model slightly attenuated the hazard for CVD (HR 1.20 [95% CI 1.07, 1.35]), CABG (HR 1.25 [95% CI 1.00, 1.06]), and stroke (HR 1.18 [1.01, 1.37]) in women who consumed ≥1 serving/day in comparison to women that rarely/never consumed SSBs. Conclusions: If this finding is replicated, SSB consumption might be a modifiable dietary target to reduce risk of CVD among women.