Giving Birth Tied to Increased CVD, Stroke Risk

Women who have given birth may have a significantly higher risk for cardiovascular disease (CVD) and stroke compared with women who have never had children, and the risk appears to increase with each live birth, new research suggests.

Investigators conducted a meta-analysis of 10 studies involving more than 150,000 cases of CVD among more than 3 million participants and found a 14% higher risk with parity vs nulliparity.

Moreover, when the association was analyzed with respect to the number of births, the investigators found a J-shaped relationship, in which each birth was associated with a 4% higher likelihood of developing CVD, regardless of factors such as body mass index (BMI), diabetes, hypertension, smoking, and income levels.

Each live birth was associated with a 5% higher risk for coronary heart disease (CHD) and a 4% higher risk for stroke.

“We think doctors could play a role in the dissemination [of these findings] for women patients,” study author Dongming Wang, MD, of the Department of Occupational and Environment Health, School of Public Health, Tongii Medical College, Huazhong University of Science and Technology, Hubei, China, told Medscape Medical News.

“The doctors could tell them that ever-parity is related with CVD risk and there is an association between number of pregnancies and risk for CVD,” he said.

The study was published online December 19 in the European Journal of Preventive Cardiology.

Controversial Findings

“Many studies have shown that reproductive factors may affect women’s health in later life, and parity as an important reproductive factor has also been shown to play an important role in the development of CVD,” Wang said.

The association, however, “remains controversial, given the inconsistency of previous findings. Thus, we aimed to conduct a meta-analysis of cohort studies to quantitatively assess the association between parity and CVD risk,” he reported.

To investigate the question, the researchers searched PubMed and Web of Science to identify studies on parity and CVD risk through June 7, 2018. They used the search terms “cardiovascular disease,” “coronary heart disease,” “ischemic heart disease,” and “stroke.”

Studies were required to have a cohort design, with parity number as the exposure of interest. CVD risk, rather than CVD mortality, was the required outcome.

Additionally, studies had to report relative risks (RRs) with 95% confidence intervals (CIs) for ≥3 quantitative categories of parity numbers, or to provide risk estimates per live birth.

To analyze dose and response, the researchers assigned the median or mean parity number in each category to the corresponding RR for each study.

Increased Cardiometabolic Changes

From a total of 4746 citations identified in the initial literature search, the researchers included 10 cohort studies (all published between 1987 and 2018) in the meta-analysis. Of these, nine studies (13 records) analyzed parous vs nulliparous women, and eight studies (11 records) included the dose-response analysis of parity number.

Studies were conducted in Sweden (n = 1), the United States (n = 4), China (n = 2), the United Kingdom (n = 2), and in multiple European countries (n = 1).

Study samples ranged from 867 to 1,332,062 women; the number of CVD cases ranged from 45 to 65,204; and the average duration of follow-up ranged from 6 years to 52 years.

All studies were considered to be of high quality.

For the nine studies that compared parous to nulliparous women (n = 3,014,987 participants and 148,169 CVD cases), the RR of CVD for ever-parity vs nulliparity was 1.14 (95% CI, 1.09 – 1.18), with moderate heterogeneity (I 2 = 62.0%; P = .002).

A sensitivity analysis that excluded one study at a time from the pooled estimate had “little impact” on the overall effect size.

For the eight studies that focused on the relationship between parity number and CVD risk (n = 3,051,107 participants and 144,163 CVD cases), the summary risk estimates for an increase of one live birth was 1.04 (95% CI, 1.02 – 1.05).

The researchers note that “significant heterogeneity” (I 2 = 89.6%) was found in these studies.

Additionally, they observed a J-shaped association in the nonlinear dose-response meta-analysis of parity number and CVD risk when using a cubic spline model.

Similar associations were found between parity number and CHD, ischemic heart disease, and stroke risk.

Egger’s and Begg’s tests showed no publication bias in any of the studies.

The researchers conducted subgroup analyses to “explore the potential source of statistical heterogeneity among the studies and assess the stability of the results.”

These analyses evaluated category of CVD, geographical location, whether there was adjustment for BMI, diabetes mellitus, hypertension, cigarette smoking, income, physical activity, and cholesterol.

They found that the associations of parity number with risk for CVD were similar in subgroup analyses.

“We found a significant association between parity and CVD risk when comparing parity with nulliparous,” Wang summarized.

“In the dose-response analysis, we observed a potential nonlinear J-shaped dose-response relationship between the number of births and CVD risk,” he added.

Wang described the biological mechanisms underlying these associations as “complex.”

He suggested that pregnancy “could lead to the accumulation of abdominal fat, endothelial dysfunction, atherosclerosis, and increased pro-atherogenic lipid levels and systemic inflammation.”

These cardiometabolic changes “may permanently impact the cardiovascular system, leading to a higher risk of CVD in parous women later in life,” he said.

Not Necessarily Applicable to Stroke

Commenting on the study for Medscape Medical News, Cheryl Bushnell, MD, MHS, professor of neurology, vice chair of research, and chief of the stroke division, Wake Forest Baptist Health, Winston Salem, North Carolina, who was not involved with the study, said the analysis contributes to the field through “the assessment of quality of design and outcome capture for each study included in the meta-analysis.”

Moreover, “since population studies on this topic are challenging, it is always useful to combine the results from studies from a variety of countries and geographic regions into one source and perform a meta-analysis,” she continued.

“The primary take-home message is that the results of studies assessing the relationship between parity and CVD is relatively consistent, showing a small but significant increase of CVD with increasing parity,” she said.

However, despite these findings, “there are several issues not addressed in the paper,” she cautioned.

“There is no mention of whether investigators studied the impact of the number of children on fathers, since some studies have suggested that this phenomenon may not be an isolated maternal problem and the same risk for CVD may apply to fathers as the number of children increases.”

She noted that some of the studies “do not include adjustment for socioeconomic status, which could be a significant bias.”

Finally, she added, “the premise was to evaluate CVD, although the majority of studies focused on CHD, and only one included stroke — therefore, the results may not be ideally extrapolated to include stroke.”

The authors state, “Further prospective large-scale studies are warranted to confirm our findings, and to establish causality and to elucidate the underlying mechanism.”

Mediterranean Diet May Cut Stroke Risk for Women

The Mediterranean diet may do more than help you reach and maintain a healthy weight: New research suggests that women who follow it also lower their stroke risk.

But men did not reap the same benefit from the diet, which concentrates on fish, fruits, nuts, vegetables and beans, and avoids meat and dairy products.

“Simple changes in dietary habits may bring a substantial benefit regarding reducing stroke, which remains one of the leading causes of death and disability worldwide,” said lead researcher Dr. Phyo Myint. He is clinical chair of medicine at the University of Aberdeen School of Medicine in Scotland.

Although the Mediterranean diet is considered healthy, this study could not prove that the diet itself caused stroke risk to drop.

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In addition, why men’s risk for stroke isn’t also lowered isn’t yet clear, Myint said.

But, “it is widely acknowledged that men and women are very different with regard to normal physiology,” he added.

Women have unique stroke risk factors that include using oral contraceptives or hormone replacement therapy. And during pregnancy, having preeclampsia and gestational diabetes are considered risk factors for stroke, Myint pointed out.

“It may be that certain components in the Mediterranean diet may influence risk of stroke in women more than in men,” he said.

For the study, the investigators collected data on more than 23,000 men and women, aged 40 to 77, who took part in a large cancer study. The participants were followed for 17 years.

The researchers found that, overall, those who followed a Mediterranean diet cut their risk for stroke 17 percent. When looking at men and women separately, however, women saw a reduction in risk of 22 percent, while men saw a 6 percent drop in risk. The risk reduction among men, however, might be so small that it is a “chance” finding, the scientists added.

Moreover, among those with a high risk for stroke, the risk was lowered 13 percent for those who followed a Mediterranean diet, the findings showed. This association, however, was mainly due to a 20 percent reduction in risk among women, the researchers found.

The findings were published online Sept. 20 in the journal Stroke.

According to Samantha Heller, a senior clinical nutritionist at NYU Langone Medical Center in New York City, “The Mediterranean eating style, which has great variations among several different cultures, is characterized by foods high in anti-inflammatory compounds, including fiber, vitamins, minerals and healthy plant compounds.”

Previous research has suggested that the Mediterranean diet reduces the risk of heart disease, type 2 diabetes, certain cancers, obesity and declines in thinking skills, she said.

Foods such as olive oil, zucchini, lemons, hummus, tabouleh, pasta, eggplant, lentils, tomatoes, artichokes, salads and spices are staples in many parts of the Mediterranean, Heller explained.

“In contrast, the typical Western diet is high in foods that increase inflammation, such as burgers, hot dogs, steak, butter, sodium, sugary beverages, fried foods, fast and junk foods, all of which have been associated with increased risks of chronic diseases,” she said.

Heller suggests skipping the ham and cheese on white bread with mayo for lunch, and instead trying hummus on whole wheat pita with cucumbers and tomatoes. For dinner, try going meatless a few nights a week with a pasta primavera, roasted vegetables, Greek salad, quinoa and lentil-stuffed lettuce wraps, she added.

Gum disease linked to increased stroke risk: What’s new?

A new study has shown an independent association between periodontal disease and incident stroke risk. What’s interesting is routine dental care can attenuate the stroke risk.

“The more severe the periodontal disease, the higher the risk of future stroke is,” said primary investigator Dr Souvik Sen from the University of South Carolina School of Medicine in Columbia, South Carolina, US. However, individuals who regularly attend the dentist had half the stroke risk of those who do not receive regular dental care.”

Periodontal disease characterized by increased inflammation, for example, gingivitis and severe periodontitis had the strongest association with stroke risk. “The risk is about two to three times higher in individuals with severe [periodontal] disease,” said Sen. “The risk [brought about by gum disease] is similar to that of high blood pressure.”

The study involved 10,362 middle-aged individuals with no history of previous stroke participating in the Atherosclerosis Risk in Communities (ARIC) study.  The pattern of their dental visits was classified as regular (more than once a year) or episodic (only when needed or never). Within 15 years of follow-up, 584 individuals had an incident of ischaemic stroke. [Stroke 2018;doi: 10.1161/STROKEAHA.117.018990]

Selected individuals from the ARIC study (n=6,736) were included in the ancillary dental ARIC study and were assessed and classified into seven periodontal profile classes (PPCs), from A to G (healthy to severe periodontal disease). Of these, 299 went on to have an incident ischaemic stroke in the follow-up period.

Risk lower with regular dental care

The incidence of ischaemic stroke per 1,000 person-years was 1.29 for PPC-A (the reference healthy group without periodontal disease), 2.82 for PPC-B (mild periodontal disease), 4.80 for PPC-C (high gingival index score), 3.81 for PPC-D (tooth loss), 3.50 for PPC-E (posterior disease), 4.78 for PPC-F (severe tooth loss), and 5.03 for PPC-G (severe periodontal disease).

Periodontal disease was significantly associated with cardioembolic stroke (hazard ratio, 2.6, 95 percent confidence interval [CI], 1.2–5.6) and thrombotic stroke (HR, 2.2, 95 percent CI, 1.3–3.8), but not lacunar strokes.

Regular dental users had a lower risk of stroke (crude hazard ratio [HR], 0.52] vs episodic users. The risk remained lower for regular dental users after adjusting for age, sex, BMI, hypertension, diabetes, smoking, race/centre, low-density lipoprotein level, and other factors (adjusted HR, 0.77).

Oral and heart health: The connection

Association cannot prove causation. However, more studies have shown that the bacteria found in gum disease, for example, Streptococcus sanguinis, can attach to the bloodstream and damage the heart valves, resulting in endocarditis.

“Our findings support the link between gum disease and stroke. The mechanism is to do with atherosclerosis and/or atrial fibrillation,” said Sen.  “Of note, good dental hygiene can mitigate the risk. The message is that good regular dental care, including a thorough home cleaning routine with brushing and flossing and regular dentist visits, can do more for heart health.”

Massive Study Confirms: Smoking Tobacco, Not Cannabis, Increases Stroke Risk Fivefold

In 2013, on World No Tobacco Day, the European Society of Cardiology warned that smoking tobacco increases the risk of heart disease and stroke by five-fold in people under the age of 50, and doubles the risk in people over the age of 60. Prevention of smoking tobacco is the most cost-effective way to treat and prevent cardiovascular diseases, their researchers concluded.


According to the latest World Health Organization (WHO) figures, tobacco kills around 6 million people each year – up to half of its smokers. Tobacco smoking, responsible for over $1 trillion in healthcare costs and lost productivity each year, will kill more than 8 million people a year by 2030, WHO estimates.

While the world at large is concerned about how tobacco kills, there is very little focus on how cannabis heals.


According to a study of 49,321 Swedish men, who were born between 1949 and 1951 and were conscripted into military service at the age of 18 and 20, cannabis use does not increase the risk of early stroke, which tobacco smoking does.

Using cannabis more than 50 times, the researchers found, was not associated with an increased risk of stroke at age 45 or younger. Heavy cannabis users, they claim, did have a two-fold higher risk of ischemic stroke due to blood-vessel blockage, but the link disappeared after the researchers accounted for participants’ tobacco use.  The researchers concluded:

“Previous studies on cannabis and stroke are mainly clinical, retrospective, and cross-sectional. We have expanded current knowledge by examining cannabis use in young adulthood in relation to the subsequent risk of stroke in a large population-based cohort.

“We found no evident association between cannabis use and stroke, including stroke before 45 years of age. Tobacco smoking, however, showed a clear, dose–response shaped association with stroke across multivariable models.

The researchers divided the participants into groups based on their cannabis, tobacco smoking and alcohol use. They followed the participants from 1971 until 2009 to assess the initial occurrence of fatal or non-fatal strokes.

During the follow-up period, there were 1,037 first-time strokes, of which 48% were ischemic strokes and 23% were hemorrhagic strokes. In addition, 192 first-time strokes occurred before the participants turned 45, of which 40% were ischemic strokes and 27% were hemorrhagic strokes.

Participants who had a stroke were more likely overweight, heavy smokers/heavy drinkers, had low cardio respiratory fitness, low socioeconomic position in childhood, and parental history of cardiovascular disease.

Lead author Dr. Anna-Karin Danielsson, of Karolinska Institutet in Stockholm, said men who smoked at least 20 cigarettes a day were at five times the risk of stroke before age 45 and more than two times the risk by age 60. More than 90% of stroke risk was related to modifiable risk factors such as tobacco smoking, alcohol consumption, poor diet, low physical activity and hypertension, Danielsson and her team noted in their report in Stroke.

Cannabis Heals

It is proven that tobacco kills, but it is also proven that cannabis helps people quit smoking tobacco.

A pilot – randomized double-blind placebo controlled study – aimed at assessing the impact of the adhoc use of cannabidiol (CBD) in smokers who wanted to quit smoking, found that participants who received the CBD inhaler reportedly smoked 40% fewer cigarettes weekly.

CBD, a phytocannabinoid derived from cannabis, is devoid of psychoactive activity, but it possesses analgesic, anti-inflammatory, antineoplastic and chemopreventive activities. The Free Thought Project observes:

“CBD is arguably much safer than the Selective Serotonin Reuptake Inhibitors (SSRIs) currently prescribed to smokers who want to quit smoking. The SSRIs are required by the FDA to carry what is known as a “black box warning label” warning consumers of suicidal and homicidal ideations and actions.

“CBD, however, is all natural, and is apparently a threat to the DEA. Just last month, in December of 2016, the DEA made the highly controversial move to classify CBD oil as a Schedule I narcotic along with heroin, and cocaine.”

Don’t you wonder: When tobacco is addictive and lethal, why is it legal? When cannabis is safe and healthy, why is it illegal?

High-Stress Jobs May Raise Stroke Risk

People who have high-stress jobs may have an increased risk of stroke, according to a new analysis of previous research.

In their analysis, researchers looked at six studies that involved a total of nearly 140,000 people ages 18 to 75, and examined the relationship between work stress and people’s risk of stroke. The studies were between three and 17 years long.

The researchers found that people who had high-stress jobs were 22 percent more likely to experience a stroke than those who had low-stress jobs.

Moreover, those with high-stress jobs were 58 percent more likely to have an ischemic stroke, which is the most common type of stroke, caused by a blockage of blood flow in the brain, compared to people with low-stress jobs. [11 Tips to Lower Stress]

“These results revealed that being exposed to high-stress jobs was associated with an increased risk of stroke, especially for ischemic stroke,” said study author Dr. Yuli Huang, of Southern Medical University in Guangzhou, China.

When the investigators looked at the participants’ gender, they found that women with high-stress jobs were 33 percent more likely to have a stroke than those with low-stress jobs.

The researchers did not find a link between having a high-stress job and an increased risk of stroke when they only looked at men. However, this may be due to the limited number of studies included in the analysis, the researchers said.

People tend to experience high levels stress at their job when they have little control over what they have to do, are under high time pressure and have to coordinate a lot of tasks, the researchers said. Examples of such jobs include working as waiters and nursing aides, whereas examples of low-stress jobs include working as natural scientists and architects.

The study showed an association, not a cause-and-effect relationship between high levels of job stress and an increased risk of stroke.

However, the researchers suspect that “work stress may foster unhealthy behavior such as smoking, reduced physical activity, lower help-seeking behavior and poor eating habits — all of which are also important risk factors for stroke,” Huang told Live Science.

Moreover, work-related stress has also been linked with certain cardiovascular risk factors such as high body mass index, impaired metabolism of a sugar called glucose and abnormal levels of fats in the blood, which are also risk factors for stroke, Huang said.

Of the six studies included in the analysis, five adjusted the results to take the participants’ ages into account, but “most of the included studies were not adequately adjusted for other risk factors,” the authors of the new analysis noted.

“We think further studies are needed to evaluate whether job stress directly increases the risk of stroke or whether other concurrent risk factors are responsible for the increased risk observed,” Huang said.

Dr. Jennifer J. Majersik, an associate professor of neurology at the University of Utah in Salt Lake City who was not involved in the new research, said the studies included in the analysis did not always measure the participants’ metabolism or inflammation levels, which may also mediate people’s risk of stroke.

“Once there is further clarity on this issue, high job strain may be considered an independent stroke risk factor in the future — and one that is potentially modifiable,” Majersik said, writing in an editorial that was published in the journal along with the study.

Employers can help lower workers’ stress levels, for example, by allowing them greater latitude in making their own decisions at work and embracing flexible working arrangements such as telecommuting, she said.

Quick Brain Health Test For Stroke Risk.

What if we told you that trying to stand on one leg for 20 seconds (or more) could help you gauge the health of your brain? You might think we were a bit unbalanced ourselves. But that’s exactly what a new study published in the journal Stroke suggests.

Researchers at the Center for Genomic Medicine at Kyoto University in Japan asked about 1,400 people (average age 67) to stand with one leg raised and their eyes open for up to 60 seconds. Everyone tried this twice; best times were used for analysis. Then, using MRI, the researchers scanned everyone’s brain.

They found that those who struggled to balance for 20 seconds had cerebral small-vessel disease (SVD), even though they weren’t exhibiting any classic symptoms. SVD is related to stroke, dementia and even Parkinson’s. Among the balance-impaired, 15% had one micro-bleed brain lesion (30% had two) and 16% had one arterial brain blockage (35% had two.) In addition, those with the shortest balance times generally had the lowest mental performance scores.

How can standing on one leg provide insight into the brain’s health? “Balance is achieved and maintained by 3 main sensory circuits,” explains Jose Biller, MD, chair of neurology at Loyola Medicine in Maywood, IL. “Vision, proprioception [your sense of body position] and the vestibular system [inner ear, etc.].” If you were paying attention in high school anatomy, you’ll remember that the brain controls all these sensory circuits. So any loss of motor coordination, such as the inability to balance for any length of time, could suggest brain damage.

So take the balance test to see how you do. If you can’t break that 20-second threshold then, according to  Biller, you may be at increased risk for brain disease and cognitive decline. Consult with your physician.

Bacteremia Appears to Increase 30-Day Risk of MI or Stroke.

Patients who had bacteremia mainly urinary-tract infections, pneumonia, or sepsis when admitted to hospital were much more likely to have an MI or stroke within 30 days, compared with healthy controls or patients hospitalized for other reasons, in a new study [1] .

“Our study corroborates that acute infection may trigger cardiovascular events,” Dr Michael Dalager-Pedersen (Aalborg University Hospital, Denmark) told heart wire in an email. “It is the first study to demonstrate that many different bacterial infections may affect MI and stroke risk,” he added.

The research suggests that “bacteremia (a severe and acute infection) should be considered a risk factor for MI and stroke, but only for a short period of time after onset of infection,” and it hints that infection with Staphylococcus aureus may confer a particularly high risk.

“Patients admitted with signs of acute infection and bacteremia/sepsis should be monitored closely for complications, and treated early . . . with fluid therapy, oxygen, and antibiotics,” Dalager-Pedersen continued. “Moreover, it seems prudent to increase vaccination efforts (eg, influenza and pneumococcal vaccination), in particular in patients who already have established cardiovascular disease, since infection may trigger new cardiovascular events.”

Future studies are needed to clarify whether specific cardiovascular therapies (eg, antithrombotic or anti-inflammatory drugs) may reduce the risk of cardiovascular complications in patients with bacteremia, he said.

The study was published online February 12, 2014 in Circulation.

Infection a Trigger for MI, Stroke

An estimated one million Americans have an acute MI or stroke each year, and it would be useful to understand how acute infections might trigger these events, but most previous studies lacked laboratory confirmation of infection, the researchers write.

Using population-based databases, they identified 4389 patients in Northern Denmark who had positive blood cultures when admitted to hospital from 1992 to 2010. The pathogens were Escherichia coli, Streptococcus pneumoniae, S aureus, other bacteria, and fungi. Most patients had urinary-tract infections or pneumonia, while others had central nervous system infections, endocarditis, and other infections.

The mean age of patients was 73 years. Based on age, gender, and date of admission, each patient was matched with about five patients hospitalized for other reasons and about 10 individuals in the general population.

Researchers identified all incident MI and stroke events that occurred within 0 to 30 days, 31 to 180 days, and 181 to 365 days after the day of hospitalization.

Patients with community-acquired bacteremia had a greatly increased risk of MI or stroke within 30 days. At 31 to 180 days, these patients had a modestly higher risk of MI or stroke compared with healthy controls, but not compared with other hospitalized patients. No differences in cardiovascular risk were seen after more than six months.

Small Changes Make a Big Difference in Stroke Risk .

An overall measure of cardiovascular health serves as a good predictor of stroke risk, and small behavioral changes can have significant effects, a study in Stroke finds.

The measure, Life’s Simple 7 (or LS7), includes blood pressure, cholesterol, glucose, body-mass index, smoking, physical activity, and diet. Each factor is assigned a rating of up to 2 points (0, 1, or 2 for poor, average, or ideal score, respectively), for a maximum score of 14.

Researchers collected LS7 data on some 23,000 black and white Americans averaging 65 years of age without cardiovascular disease. Subjects were followed for 5 years.

Compared with adults with inadequate LS7 scores (0–4), those with average (5–9) or optimal (10–14) scores showed a 25% to 50% lower risk for stroke. A 1-point increase in LS7 score conferred an 8% lower risk.

Source: Stroke

Is Diet Soda Linked to Heart, Stroke Risk?

Study Suggests Connection Between Drinking Diet Soda and Risk of Heart Attack and Stroke
soda being poured into glass

Feb. 9, 2011 (Los Angeles) — You may feel less guilty if you opt for diet sodas over sugary beverages, but drinking them regularly may raise your risk of heart attack and stroke, a study suggests.

In a nine-year study of more than 2,500 people, those who drank diet soda daily were 48% more likely to have a heart attack or stroke or die from those events, compared with those who rarely or never drank soda.

There was no increased risk of cardiovascular disorders among daily drinkers of regular soda, says study researcher Hannah Gardener, ScD, an epidemiologist at the University of Miami Miller School of Medicine.

The analysis, presented at the American Stroke Association International Stroke Conference (ISC), took into account a host of cardiovascular risk factors including age, sex, smoking, physical activity, alcohol and calorie consumption, metabolic syndrome, and pre-existing heart disease.

Still, the study doesn’t prove cause and effect. And even though the researchers tried to account for risk factors that that could skew the results, they couldn’t tease out everything, doctors caution.

“You try to control for everything, but you can’t,” says Steven Greenberg, MD, PhD, vice chair of the ISC meeting committee and professor of neurology at Harvard Medical School.

People who drink a lot of diet soda may share some characteristic that explains the association, he explains.

Missing Variables

Maureen Storey, PhD, senior vice president of science policy for the American Beverage Association, says that the researchers failed to control for two important variables — family history of stroke and weight gain — that affect stroke risk.

Even Gardener says it’s too early to tell people to skip soda based on this study alone. “But if confirmed, diet drinks may not be an optimal substitute for sugar-sweetened beverages.”

The new study involved 2,564 people in the Northern Manhattan Study, with an average age of 69. About two-thirds of the participants were women, 21% were white, 24% African-American, and 53% Hispanic.

At the start of the study, people were asked to fill out a questionnaire that asked what foods and beverages they consumed and how often they consumed them.

They were also asked about their exercise routine, as well as whether they smoked or drank alcohol. The participants also had physical checkups.

Of the total, 901 said they never drank soda or drank it less than once a month, 282 said they drank at least one regular soda daily, and 116 reported they drank at least one diet soda daily.

Over the next nine years, 212 of them had strokes, 149 had a heart attack, and 338 died from vascular disease.

Study Drawbacks

One drawback of the study is that participants were only asked about their soda habits at one time point; they could have changed over the study period, Gardener says. Also, there was no information on the types of soft drinks drunk, she says, pointing out that variations among brands, coloring, and sweeteners could have affected the results.

Philip B. Gorelick, MD, MPH, head of neurology and stoke research at the University of Illinois in Chicago, says the food questionnaire used in the study isn’t a good way to gauge people’s overall dietary patterns.

“You have to look at what people eat in totality,” he tells WebMD. “People who are reducing calories by drinking diet soda may have an unhealthy dietary pattern, consuming a lot of fat and salt, for example. And that won’t be picked up using a questionnaire like the one used here.”

Storey says there is no diet soda-heart and stroke connection. “There is no scientific evidence to support the idea that diet soda uniquely causes increased risk of vascular events or stroke,” she says in a written statement. “The body of scientific evidence does show that diet soft drinks can be a useful weight management tool, a position supported by the American Dietetic Association. Thus, to suggest that they are harmful with no credible evidence does a disservice to those trying to lose weight or maintain a healthy weight.”

As for why diet soda might be bad for our hearts and brains, Gardener says that’s still a big question mark.

Previous research linking regular and diet soda to diabetes and metabolic syndrome, both of which are risk factors for stroke and heart attacks, may offer a clue, she says.

source: web MD

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