Sian Claire Owen, Cardio Debate medical journalist

Sugar is a key ingredient for most processed foods and sweetened beverages, as an ingredient it adds flavor and can withstand the demands of industrial food preparation – and most of all, it is low cost.  However, although the industrialisation of food has meant greater convenience and availability, these advantages have come with a high price for the consumers.

Over the past few years, more studies have shown the link between high levels of added sugars – defined as ‘all sugars added in processing or preparing food – with cardiovascular disease.

In 2014 a paper published in JAMA Internal Medicine examined the impact of added sugar consumption on CVD mortality. This study found that most US adults consume over 10 per cent of their total calories from added sugar, and approximately 10 per cent of these consume a staggering 25 per cent of their calories from added sugar. [1]

Furthermore, adults who consumed 17-21 percent of their total calories from added sugar had a 38 per cent higher relative risk of CVD mortality compared to adults who consumed eight per cent of their total calories from added sugar. [1]

The AHA currently recommends women should consume no more than six teaspoons of added sugar per day, and men no more than nine teaspoons. However, despite these guidelines, most US adults consume around 22 teaspoons of added sugars every day. [1]

In short, consuming high amounts of these added sugars – which are often hidden in (processed) foods you would not expect to find them – significantly increase your risk of death.

In November 2015, a population-based study published in Heart showed that men who consumed at least two sweetened beverages per day had a ‘statistically higher risk’ of developing heart failure compared to men who did not drink these beverages. [2]

More recently a paper published in Progress in Cardiovascular Disease looked at evidence that showed an association between saturated fats and sugars with CHD, respectively. They found that refined carbohydrates were more detrimental to people’s health. [3]

The study authors wrote that: “Advice to reduce saturated fat in the diet without regard to the nuances about LDL, SFAs, or dietary sources could actually increase people’s risk of CHD,” adding that: “When saturated fats are replaced with refined carbohydrates, and specifically with added sugars, the end result is not favourable for heart health.” [3]

As the evidence stacks up, the US and UK dietary guidelines must adapt accordingly. It may well be that saturated fat is not the demon we thought it was, and refined carbohydrates, added sugars, are the real enemy in the fight against CVD.


  1. Yang Q, Zhang Z, Gregg EW, et al. Added sugar intake and cardiovascular disease mortality among US adults. JAMA Intern Med 2014; 174(4): 516-24.
  2. Rahman I, Wolk A, Larrson SC. The relationship between sweetened beverage consumption and risk of heart failure in men. Heart doi:10.1136/heartjnl-2015-307542.
  3. DiNicolantonio JJ, Lucum SC, O’Keefe JH. The evidence for saturated fat and for sugar related to coronary heart disease. Prog Cardiovasc Dis 2016; 58(5): 464-72.