title: Soft drinks and sweetened beverages and the risk of cardiovascular disease and mortality: a systematic review and meta-analysis.
abstract: BACKGROUND
  Soft drink consumption is associated with adverse health behaviours that predispose to adverse cardiovascular risk factor profiles; however, it is unclear whether their intake independently leads to an increased risk of cardiovascular events and mortality. We conducted a systematic review and meta-analysis to evaluate this.
  
  
  METHODS
  Medline and EMBASE were searched in July 2015 for studies that considered soft drink intake and risk of mortality, myocardial infarction (MI) or stroke. Pooled risk ratios (RRs) for adverse outcomes were calculated using inverse variance with a random effects model, and heterogeneity was assessed using the I2statistic.
  
  
  RESULTS
  A total of seven prospective cohort studies with 308,420 participants (age range 34-75 years) were included in the review. The pooled results suggest a greater risk of stroke (RR 1.13, 95% CI 1.02-1.24), and MI (RR 1.22, 95% CI 1.14-1.30), but not vascular events with incremental increase in sugar-sweetened beverage (SSB) consumption. With incremental increase in artificially sweetened beverage (ASB) consumption, there was a greater risk of stroke (RR 1.08, 95% CI 1.03-1.14), but not vascular events or MI. In the evaluation of high vs. low SSB, there was a greater risk of MI (RR 1.19, 95% CI 1.09-1.31) but not stroke, vascular events or mortality. For ASB, there was a significantly greater risk of stroke (RR 1.14, 95% CI 1.04-1.26) and vascular events (RR 1.44, 95% CI 1.02-2.03) but not MI or mortality.
  
  
  CONCLUSIONS
  Our results suggest an association between consumption of sugar-sweetened and ASBs and cardiovascular risk, although consumption may be a surrogate for adverse health behaviours.
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK. aditya@hotmail.co.uk.
authors.forename: A
authors.initials: A
authors.lastname: Narain
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.|University Hospital of North Midlands, Stoke-on-Trent, UK.
authors.forename: C S
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.|University Hospital of North Midlands, Stoke-on-Trent, UK.|Farr Institute, University of Manchester, Manchester, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D000328:Adult; D000368:Aged; D002253:Carbonated Beverages / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D015331:Cohort Studies; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment