BACKGROUND:

With the rising use of artificial sweeteners as sugar substitutes, concerns regarding their impact on cardiovascular health have emerged. Despite approval by national food regulatory agencies, evidence of their association with clinically significant cardiovascular events remains inconclusive. This study aimed to assess this relationship through a systematic review and meta-analysis.

METHODS:

PubMed, Embase, and Cochrane databases were systematically searched for cohort studies investigating the incidence of stroke, cardiovascular death (CVD), coronary heart disease (CHD), and all-cause mortality (ACM) among individuals with high consumption of artificially sweetened beverages (ASBs) compared to minimal or no consumption. Pooled event prevalence and hazard ratios (HR) with 95% confidence intervals (CI) were calculated using a random-effects model in R software, with heterogeneity assessed via I2 statistics.

RESULTS:

After overlapping population disposal, eight cohorts comprising 917,971 patients (mean age 52 years; 67.7% female) were included. Analyses were conducted on patient groups with data adjusted for dietary factors, comorbidities, and family history of heart disease. High Consumption of ASBs was significantly associated with a higher risk of ACM (HR 1.1760; 95% CI 1.0186-1.3578, p=0,027), stroke (HR 1.2501; 95% CI 1.0555-1.4807, p=0,01) and CVD (HR 1.4722; 95% CI 1.2821-1.6905, p<0,001). There was no statistically significant association found for CHD (HR 1.1215; 95% CI 0.9280-1.3554, p=0,235).

CONCLUSION:

In this meta-analysis, we found a significant association between high consumption of ASBs and increased incidence of ACM, CVD, and stroke highlighting potential cardiovascular implications. Further studies with improved methodologies are needed to corroborate these findings and elucidate the underlying mechanisms.