Hannah Gardener, Tatjana Rundek, Clinton Wright,

Julio Vieira, Mitchell S.V. Elkind, Ralph L. Sacco

University of Miami Miller School of Medicine, Miami, FL and Columbia University, New York, NY

Funded by: a grant from the NINDS (R37 NS 29993)and The Evelyn F. McKnight Brain Institute

Presenter Disclosure InformationHannah Gardener, ScDSoda Consumption and Risk of Vascular Events in

the Northern Manhattan Study

FINANCIAL DISCLOSURE:No relevant financial relationship exists

Background and Objective Previous studies have shown that both diet and regular soft drink

consumption are associated with two important risk factors for vascular disease Diabetes and the metabolic syndrome (3+: elevated waist

circumference, blood pressure, blood sugar, triglycerides, and decreased HDL cholesterol)

One large study of female nurses showed that regular soft drink consumption, but not diet soft drinks, was associated with an increased risk of coronary heart disease. (Fung et al, AJCN, 2009)

No studies have examined the relationship between diet soft drink consumption and risk of combined vascular events, including stroke.

Study objective: To examine the relationship between diet and regular soft drink consumption and risk for vascular events (stroke, myocardial infarction (MI), and vascular death) in a multi-ethnic population.

1993 1998 2003 2008 2015

BASELINE ASSESSMENTSociodemographicsVascular Risk ProfileBP MeasuresAnthropometricsFasting bloodsNeurogical ExamDiet questionnaire

NOMAS N = 3,298Soda data N=2,735Excluded 171 with previous MIStudy N=2,564

36% men, mean age 69 ± 10 years, 20% white, 23% black, 53% Hispanic

Annual Follow-upPhone Screen, In-person Validation, Hospital Surveillance

Stroke MI Death

NORTHERN MANHATTAN STUDY (NOMAS)

Soft drink consumption Baseline: modified Block National Cancer Institute food

frequency questionnaire. Assessed dietary patterns over the previous year.

Included questions about the frequency of diet and regular soft drink consumption.

Outcome Ascertainment

Primary outcome = incident vascular events (stroke, MI, or vascular death) Confirmed by medical record review.

Over a mean follow-up of 9.3 years, 559 new vascular events occurred. 212 strokes (178 ischemic strokes), 149 MIs, and 338

vascular deaths

Soft drink consumption and vascular risk factors

Diet soft drink consumption associated (p<0.05) with:

White race

Diabetes and elevated blood sugar

Low HDL

Elevated waist circumference and BMI

Peripheral vascular disease

Metabolic syndrome

Regular soft drink consumption associated (p<0.05) with:

Black race

High total calories consumed/day

Low HDL

Soft drinks and vascular events

Conclusions Diet soft drink consumption was infrequent in our multi-ethnic adult

population.

In our study diet soft drinks were associated with a greater risk of vascular events than regular soft drinks.

Diet soft drinks may not be an optimal substitute for sugar-sweetened beverages.

Limitations: potential misclassification of soft drink consumption due to self-reported recall of diet, no information on types of diet and regular soft drinks consumed, information on soft drink consumption at only 1 time point, and possible residual confounding.

Further studies are needed to confirm our findings and explore potential mechanisms for the association between diet soft drink consumption and vascular events.