Adverse Effects on Risk of Ischaemic Heart Disease of Adding Sugar to Hot Beverages in Hypertensives Using Diuretics: A Six Year Follow-up in the Copenhagen Male Study

Abstract

Suadicani P, Hein HO, Gyntelberg F. Adverse effects on risk of ischaemic heart disease of adding sugar to hot beverages in hypertensives using diuretics.

Non insulin dependent diabetes mellitus (NIDDM) and essential hypertension (EH) are two of several manifestations of the insulin resistance syndrome. Although subjects with NIDDM and subjects with EH share a common defect in carbohydrate metabolism, only diabetics are advised to avoid sugar. We tested the theory that an adverse effect of diuretics treatment in men with EH with respect to risk of ischaemic heart disease (IHD) would depend on the intake of dietary sugar using sugar in hot beverages as a marker. The cohort consisted of 2, 899 men from the Copenhagen Male Study aged 53-74 years (mean 63) who were without overt cardiovascular disease. Potential confounders were: age, alcohol, smoking, physical activity, body mass index, blood pressure, fasting lipids, cotinine, NIDDM, and social class. A total of 340 men took antihypertensives; 211 took diuretics (95% thiazides and related agents), and 129 used other antihypertensives. During 6 years, 179 men (6.2%) had a first IHD event. Among the 340 men taking antihypertensives, the incidence rate was 11%. Diuretics use was associated with a high risk of IHD in hypertensive men with a relatively high intake of dietary sugar; the cumulative incidence rate was 22%; in diuretics treated men with a low intake of sugar, the rate was 7%. After controlling for potential confounders, relative risk (95% c.i.) was 3.1 (1.3-7.6), p = 0.01. Among the 129 men who took other forms of antihypertensive drugs, the IHD incidence rate was 8%, and independent of the intake of sugar. The results indicate that the risk of IHD in hypertensives using diuretics is associated with intake of dietary sugar, which may explain at least some of the discouraging effects of antihypertensive agents on the reduction of risk of IHD.

Key Words:

• diuretics
• epidemiology
• hypertension
• insulin resistance syndrome
• ischaemic heart disease
• risk
• sugar