In response to “Diet Drink Consumption and the Risk of Cardiovascular Events: A Report from the Women’s Health Initiative,” an abstract presented yesterday at the American College of Cardiology’s 63rd Annual Scientific Session & Expo, the American Beverage Association issued the following statement:



“This study’s actual results do not show that drinking diet beverages causes cardiovascular events among any population.  The lead author also states this in a news release.  Being overweight, however, is a major risk factor for heart disease.  Diet beverage consumption has been shown to help with weight loss as part of an overall weight management plan, with numerous studies repeatedly demonstrating their benefits in helping to reduce calorie intake.”


Additional Background:

On the Abstract:

This is an abstract being presented at a scientific meeting.  It has not yet been peer-reviewed nor published.  Furthermore, neither the methodology nor the details of the study are available to be fully evaluated. This is an observational study which cannot establish causation.  In fact, the lead author of this research acknowledges this fact in a news release promoting his findings where he states ‘we can’t say that diet drinks cause these problems.’  What we do know from the abstract and news release is that a three-month dietary recall, including diet beverage consumption, was obtained only one time by questionnaire throughout the eight year period.  This is far from an accurate assessment of total diet and physical activity levels over time. The women who had the greatest risk of cardiovascular effects consumed two or more diet beverages per day.  However, they also had higher incidence of smoking, diabetes, hypertension and overweight – all known risk factors for heart disease. Thus, it is impossible to attribute their cardiovascular health issues to their diet beverage intake. Additionally, the group of women studied over the eight year period had an average age of nearly 63 at the beginning of the study.  Yet, the National Heart Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH) notes that, for women, being 65 years or older is a risk factor for cardiovascular disease. Importantly, according to the American Heart Association, more than 70 percent of women ages 60 to 79 have cardiovascular disease.

On Heart Disease:

Heart diseases are a complex set of problems with no single cause and no simple solution.  According to the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH), the major risk factors for heart disease are:  high blood pressure, high blood cholesterol, diabetes, smoking, being overweight, being physically inactive, unhealthy diet and stress. The most likely explanation for the association the authors found in their research is “reverse causality,” meaning those who are overweight – and therefore at greater risk for heart disease – consume diet beverages in an effort to control their weight.  Thus, it is highly probable  that being overweight leads to greater diet beverage consumption, not that diet beverage consumption leads to obesity or obesity-related conditions such as heart disease. While many risk factors are beyond our control, there are things we can do - including not smoking, maintaining an appropriate body weight and being physically active - to help mitigate risk for heart disease. According to the National Heart Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH), heart disease and stroke risk factors that can be controlled are high blood pressure or hypertension; abnormal blood cholesterol levels; tobacco use; diabetes; overweight; and physical inactivity. Risk factors beyond our control include age, that is being 55 years and older for men and 65 years or older for women; family history of early heart disease; or family history of stroke.


On Low-Calorie Sweeteners and Diet Beverages:

The CHOICE study, published in the American Journal of Clinical Nutrition, confirms that diet beverages can be an important tool in helping reduce calories and directly counters the illogical assertion that drinking diet beverages causes people to eat more or to want sweet foods and beverages.  (Accessed at: A paper published in Nutrition Bulletin also showed that “using foods and drinks sweetened with aspartame … is an effective way to maintain and lose weight without losing the palatability of the diet.” (Accessed at:,%20Gibson%20and%20Ashwell.pdf) A paper published in the International Journal of Obesity concluded that weight loss maintainers use a number of dietary strategies to accomplish their weight loss, including “increased consumption of artificially sweetened beverages.” (Accessed at: A review in Nutrition Reviews that examined the role of low-calorie sweeteners and weight management found that “to date, prospective observational studies have revealed mixed results, and it appears that reverse causality is a particular problem, since individuals who are at high risk for weight gain may choose to consume artificially-sweetened beverages in an attempt to control their weight or reduce disease risk.” (Accessed at:

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The American Beverage Association is the trade association representing the broad spectrum of companies that manufacture and distribute non-alcoholic beverages in the United States.  For more information on ABA, please visit the association’s website at or call the ABA communications team at (202) 463-6770.