Capsule Commentary on Vyas et al., Diet Drink Consumption and the Risk of Cardiovascular Events: A Report from the Women’s Health Initiative
Clement J. Zablocki VAMC and Medical College of Wisconsin
Corresponding Author: Cynthia Kay, MD MS; Clement J. Zablocki VAMC and Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA (e-mail: ).
T from the Womens Health Initiative assessing the
relahis study by Vyas et al. is a retrospective report on data
tionship between the amount of diet soda consumed and
incidence of cardiovascular disease (CVD).1 Nearly 60,000
postmenopausal women without known CVD were evaluated
and followed for 610 years. Diet soda intake was categorized
into four groups: 03 drinks per month, 14 drinks per week,
57 drinks per week, and 2 or more drinks per day.
After adjusting for a multitude of factors, including CVD
risk and demographic characteristics, women who
consumed 2 drinks/day had a higher risk of CVD events and
mortality compared to women who drank 03 drinks/month.
The authors also found an interesting interaction between BMI
and diet drink intake, which could be further explored.
All observational epidemiological studies are prone to a
number of important confounding variables that could
produce biased results. In this study, there were differences
between participants who were included in the study and those
who were excluded, and the studys main focus relied on
participants responses to questionnaires. In addition, dietary
data was obtained at baseline and three years after enrollment,
and it is reasonable to assume that dietary behavior, including
the number of diet drinks consumed, would vary over the years.
While diet soda is often considered a better alternative to
regular soda, past studies have suggested that its consumption
is tied to increased obesity,2 metabolic syndrome,2 and
diabetes.3 This study offers further support that diet soda should not
be considered a healthier substitute. However, the number of
potential confounders in the relationship between diet soda
and CVD is considerable. At most, such data should be
cautiously interpreted to mean that there might be an
association between the two. Medical history is rife with examples
of putative relationships based on epidemiologic data, such as
the benefit of estrogen for postmenopausal women or the
importance of magnesium for heart attack survival, both of
which proved to be unsubstantiated when studied more
rigorously. Further research regarding the possible association
between diet soda and CVD certainly remains an area of interest.