Background Despite the well-characterised association between sweetened beverage intake and development of cardio-metabolic risk factors, the relationship between sweetened beverage intake and cardiovascular disease and mortality is controversial. A systematic review and meta-analysis was conducted to evaluate the relationship between sweetened beverages and cardiovascular events and mortality.

Methods Medline and EMBASE were searched in July 2015 for studies that considered soft drink intake and their association with risk of mortality, coronary heart disease (CHD) or stroke. Pooled risk ratios for adverse outcomes were calculated using inverse variance with a random effects model, and heterogeneity was assessed using the I² statistic.

Results 8 studies with 308,810 participants (34–75 years) were included in the review. Pooled results suggest a significant increase in stroke RR 1.13 95% CI 1.02–1.24, and CHD RR 1.22 95% CI 1.14–1.30 with incremental increase in sugar-sweetened beverage (SSB) consumption. For stroke and CHD, there were significant increases with greater incremental increase in artificially sweetened beverage (ASB) consumption (stroke RR 1.13 95% CI 1.02–1.24, CHD RR 1.22 95% CI 1.14–1.30), but not vascular events. For high versus low SSB, there was a significant increase in CHD (RR 1.19 95% CI 1.09–1.31) but not stroke, vascular events or mortality. For ASB, there was a significant increase in stroke (RR 1.14 95% CI 1.04–1.26) and vascular events (RR 1.44 95% CI 1.02–2.03) but not CHD.

Conclusions Current evidence suggests an association between increased cardiovascular risk and greater consumption of sugar-sweetened beverages, although consumption may be a surrogate for adverse health behaviours.