HealthDay News — Higher intake of added sugar is associated with an increased risk of dying from cardiovascular disease, according to researchers.

During a median 15-year follow-up period, those who had 10% to 24.9% of calories come from added sugar were 30% more likely to experience cardiovascular death than those with less than 10%, Quanhe Yang, PhD, of the CDC in Atlanta, and colleagues reported in JAMA Internal Medicine.

For those who consumed more than 25% of their calories from added sugar cardiovascular mortality risk increased  to 175% (HR 2.75, 95% CI 1.40-5.42), the researchers found.

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They analyzed data from the National Health and Nutrition Examination Survey to examine the association between added sugar intake and CVD mortality in adults. The study included 31,147 people who participated in the survey from 1988 to 2010 for a time trend analysis, and 11,733 who were included in the wave from 1988 to 1994 and were followed through 2006 for the mortality analysis.

All participants completed 24-hour dietary recalls that were used to determine intake of added sugar, which did not include sugar from fruit or fruit juices. The average proportion of daily calories that came from added sugar increased from 15.7% in 1988-1994 to 16.8% in 1999-2004, but then declined to 14.9% in 2005-2010, the researchers found.

Overall, 71% of participants consumed 10% or more of their daily caloric intake from added sugar and about 10% of adults consumed 25% or more of calories from added sugar.

After multivariable adjustment for sociodemographics, overall diet quality and various cardiovascular risk factors, adjusted hazard ratios for CVD mortality, compared with participants who consumed less than 10% of calories from added sugar, were 1.30 (95% CI: 1.09 to 1.55) for those who consumed 10% to 24.9% of calories from added sugar and 2.75 (95% CI: 1.40 to 5.42; P=0.004) for those who consumed 25% or more of calories from added sugar.

For sugar-sweetened beverages specifically, participants who consumed at least seven servings per week had a greater risk of cardiovascular mortality compared with those who consumed no more than one (HR 1.29, 95% CI: 1.04-1.60).

“[The study] underscores the likelihood that, at levels of consumption common among Americans, added sugar is a significant risk factor for CVD mortality above and beyond its role as empty calories leading to weight gain and obesity,” Laura Schmidt, PhD, MPH, of the University of California San Francisco, wrote in an accompanying editorial.

Processed and prepared food, including soda and other sugar-sweetened beverages, desserts, fruit drinks and candy, typically have high levels of added sugars. For example, a typical can of regular soda contains about 35 grams of sugar — the equivalent of about 7% of total calories in a 2,000 calorie/per day diet.

Previous studies have linked added sugar from sugar-sweetened beverages to increased risk for cardiovascular disease, diabetes, hypertension, weight gain and obesity.

Currently, several public health organizations have guidelines available to limit added sugar consumption. The Institute of Medicine says that less than 25% of calories should come from added sugar, whereas the World Health Organization recommends a more conservative 10% threshold. The American Heart Association states that women should consume no more than 100 calories per day from added sugar and men should consume no more than 150 calories per day.

“Yang et al. underscore the need for federal guidelines that help consumers set safe limits on their intake as well as evidence-based regulatory strategies that discourage excess sugar consumption at the population level,” Schmidt said.


  1. Yang Q et al. JAMA Intern Med. 2014; doi: 10.1001/jamainternmed.2013.13563.
  2. Schmidt L. JAMA Intern Med 2014; doi: 10.1001/jamainternmed.2013.12991.