title: Diet drink consumption and the risk of cardiovascular events: a report from the Women's Health Initiative.
abstract: BACKGROUND
  Data are limited regarding the influence of diet drink consumption on cardiovascular disease (CVD) outcomes.
  
  
  OBJECTIVE
  We aimed to evaluate the relationship between diet drink intake and cardiovascular events.
  
  
  METHODS
  We conducted a retrospective cohort study, utilizing data from the national, multicenter Women's Health Initiative Observational Study (WHI OS), recruiting subjects from 1993 to 1998.
  
  
  METHODS
  Post-menopausal women with available diet drink intake data, without pre-existing CVD and who survived ≥ 60 days were included in the study.
  A composite of incident coronary heart disease, heart failure, myocardial infarction, coronary revascularization procedure, ischemic stroke, peripheral arterial disease and CVD death was used as the primary outcome. CVD death and all-cause mortality were secondary outcomes. Adjusted Cox proportional hazards models were used to compare primary and secondary outcomes across diet drink intake strata.
  
  
  RESULTS
  In all, 59,614 women, mean age 62.8 years, were included for analysis. In unadjusted analysis over a follow-up of 8.7 ± 2.7 years, the primary outcome occurred in 8.5 % of the women consuming ≥ 2 diet drinks/day, compared to 6.9 %, 6.8 % and 7.2 % in the 5-7/week, 1-4/week and 0-3/month groups, respectively. After controlling for other CVD risk factors, women who consumed ≥ 2 drinks/day had a higher adjusted risk of CVD events (HR 1.3, 95 % CI 1.1-1.5), CVD mortality (HR 1.5, 95 % CI 1.03-2.3) and overall mortality (HR 1.3, 95 % CI 1.04-1.5) compared to the reference group (0-3 drinks/month).
  
  
  CONCLUSIONS
  This analysis demonstrates an association between high diet drink intake and CVD outcomes and mortality in post-menopausal women in the WHI OS.
authors.affiliation: Division of Cardiovascular Medicine, University of Iowa Hospitals & Clinics, 200 Hawkins Dr., Int. Med. E316-1 GH, Iowa City, IA, 52242, USA, ankurvyas7@gmail.com.
authors.forename: Ankur
authors.initials: A
authors.lastname: Vyas
authors.forename: Linda
authors.initials: L
authors.lastname: Rubenstein
authors.forename: Jennifer
authors.initials: J
authors.lastname: Robinson
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Seguin
authors.forename: Mara Z
authors.initials: MZ
authors.lastname: Vitolins
authors.forename: Rasa
authors.initials: R
authors.lastname: Kazlauskaite
authors.forename: James M
authors.initials: JM
authors.lastname: Shikany
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.forename: Linda
authors.initials: L
authors.lastname: Snetselaar
authors.forename: Robert
authors.initials: R
authors.lastname: Wallace
mesh_terms: D000368:Aged; D002253:Carbonated Beverages / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D058028:Research Report / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D013549:Sweetening Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016387:Women's Health / Q000639:trends
chemical_list: D013549:Sweetening Agents