Unlikely Cardioprotection

Published February 1, 2025

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The Sweet Spot for Sugar Intake and Cardioprotection

CARDIO CORNER

Anyone over age 6 knows the harms of consuming excessive sugar, but do the amount and type of sugary treat matter for cardiovascular and overall health? Investigators of a new study reached a conclusion as unexpected as a 2025 Oasis tour—too little sugar may pose greater harm than too much

Leave the soda, take the cannoli

We’ll skip the sugar puns and keep this summary short and sweet. In an observational study of nearly 70,000 Swedish adults, researchers mapped participants’ self-reported intake of sugary foods and beverages to their risk of seven CV diseases via national registry records through 2019. Unsurprisingly, a general link between added sugar consumption and cardiovascular disease (CVD) emerged. But individuals who bore the greatest overall risk of CVD consumed only trace amounts or no added sugar. Further, researchers spotted these intriguing patterns:

• Sweetened beverages were public enemy number one, driving up the risk of ischemic stroke, heart failure, atrial fibrillation, and abdominal aortic aneurysm.
• Toppings like table sugar and honey fueled abdominal aortic aneurysm but reduced risks of heart failure and aortic stenosis.
• Treats like pastries and ice cream cut risks across all outcomes.

Bittersweet results 

Let’s take these findings with a grain of granulated sugar. First, this study leans on observational, self-reported data, so participants—unless they’re Buddy the Elf—likely lowballed their sugar habit. Second, the results may not generalize beyond Sweden, where love of pastry runs so deep they’ve institutionalized “fika,” a daily excuse to pair coffee with sweets. Finally, a sugar-restricted diet could signal underlying health issues skewing the results.

Key takeaways 

This study gives Big Sugar an early Valentine. Sugar consumption in moderation—ideally under the American Heart Association (AHA) recommendation of <6 to 9 tsp per day—may confer cardiovascular perks. But don’t sugarcoat it for patients. It appears that not all indulgences are created equal, and downing soda “for the heart” in the name of this study begs intervention.

To learn about the effects of added sugar in coffee, check out this Frankly Speaking podcast episode: A Spoonful of Sugar in Your Cup of Joe—Does It Affect Your Health

Guideline Updates

• SPRAVATO (esketamine) approved in the U.S. as the first and only monotherapy for adults with treatment-resistant depression
• FDA pushes for buprenorphine labeling changes to facilitate higher doses
• Screening for osteoporosis to prevent fractures: US Preventive Services Task Force Recommendation Statement
• FDA approves Johnson & Johnson’s nasal spray for depression as stand-alone treatment

BMI vs Cardiorespiratory Fitness for Longevity

CARDIO CORNER

Does the body mass index (BMI) hold clinical value? Clinicians have questioned its relevance for years, and skepticism went mainstream 20 years ago when Tom Brady famously exposed its weakness—as well as the Bill's defense. The Gaston-shaped QB—indulging only in avocado ice cream and comeback victories—met BMI requirements for "overweight", nearing "obesity". And now a study suggests this flawed metric may also focus on the wrong health factor. 

Fit trumps fat

A recent meta-analysis—the largest of its kind—rehashed the debate over whether a healthy BMI or cardiorespiratory fitness (CRF) offers greater influence over longevity. Researchers crunched data from 20 prospective cohort studies, totaling nearly 400,000 participants over four decades. Using normal weight-fit individuals as the gold standard, the study evaluated how different combinations of BMI and CRF affected CVD and mortality risk.

• Those in the normal weight-fit group had no advantage over counterparts in the overweight-fit or obese-fit groups in terms of CVD or all-cause mortality risks.
• Being unfit, regardless of weight, spiked risks: Individuals in the normal weight-unfit group had nearly double the mortality risk, and those in the obese-unfit group faced a 3.35-fold increase in CVD mortality.

Key takeaways 

These findings affirm that fitness eclipses BMI for CV health and longevity. This crude metric has been circling the drain for years and may be officially ready for retirement. (Although, looking again at Tom Brady, we know that’s easier said than done.) Consider reframing discussions about weight to focus on fitness. Gently nudge patients away from the number on the scale and toward goals tied to their step count, heart rate, or pickleball scores. The study showed that even modest improvements—like climbing out of the bottom 20% of age-related fitness—yielded substantial health gains.

For more education on exercise for better health, check out this CME activity: Diving Deeper into Exercise Regimens for Cardiometabolic Health

In Bizarre Heart News ...

Did you know that nine in ten organ recipients report personality shifts? Mounting evidence suggests these patients may be receiving more than just a new heart. They may be “inheriting” fragments of their donor’s identities, perhaps from a transfer of “cellular memory.” The changes may hit as subtly as a budding appetite for KFC or as brutally as a sudden disdain for your soulmate. And this: A never-biker swapped his heart for that of a champion cyclist and then crushed a 342-mile race. The science is murky—more to come on these literal and figurative changes of heart.

Answering SPRINT’s Lingering Cognitive Risk Questions

CARDIO CORNER

That moment when a clinical trial shuts down early for undeniable efficacy. When the guideline-shifting SPRINT trial halted prematurely in 2015, it definitively showed that stricter systolic blood pressure (SBP) control dramatically slashed CV risks. But what about its impact on dementia risk, the trial’s other outcome? SPRINT’s truncated timeline left cognitive decline undertracked and questions unanswered. A recent follow-up reopened these questions.

Refresher on SPRINT

Beginning in 2010, researchers randomly assigned >9,000 patients aged 50+ with hypertension and increased CV risk to either intensive treatment (SBP goal <120 mm Hg) or formerly standard treatment (<140 mm Hg) for 3.3 years, with cognitive assessments through 2018.

SPRINTing ahead

In the secondary analysis, researchers reconnected with ~7,000 eligible participants in 2019, determining the cognitive status of approximately 4,000. Over a median follow-up of seven years, researchers flagged 216 patients with probable dementia, notably shy of the 326 cases needed for statistical power. Still, the intensive treatment group logged 14% fewer dementia cases than the standard treatment group (248 vs 293). More strikingly, rates of mild cognitive impairment (MCI) and a combined outcome of MCI or probable dementia showed a clear and statistically significant edge for intensive treatment.

Key takeaways 

SPRINT continues to deliver a pipeline of insights. This latest analysis strengthens the case for tighter blood pressure control for cognitive protection. It’s yet another reason to treat to a target of <130/80 mm Hg, per ACC/AHA guidelines. Study author Dr. Jeff Williamson sums it up: “Our study shows that intensive blood pressure control is an important strategy in the prevention of cognitive impairment, a major cause of loss of independence.” 

For more education on cardiology and related topics, check out Pri-Med's newest seminar: Updates in Cardiometabolic Health