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Added Sugars Drive Coronary Heart Disease via Insulin Resistance and Hyperinsulinaemia: A New Paradigm

ByCrossFitDecember 30, 2019

This short 2017 review surveys evidence linking sugar intake to heart disease.

Half of heart attack patients are diabetic, and nearly three-quarters have impaired glucose tolerance. Elevated blood glucose, insulin, and insulin resistance independently increase risk for heart disease based on data in a variety of populations (1). Diabetics, specifically, have triple the heart disease risk of nondiabetics, have an increased risk even after adjusting for the higher-risk lipid profile often seen alongside diabetes (2), and those diabetics who do have a heart attack are less likely to survive (3).

Calorie for calorie, added sugars increase fasting glucose, fasting insulin, and insulin resistance more significantly than starches or other nutrients (4). Increased sugar intake also has been linked to impaired platelet function, increased triglycerides, increased uric acid, and reduced HDL cholesterol, all of which are independent cardiovascular disease risk factors (5).

Taken together, this body of evidence suggests increased consumption of added sugars increases heart disease risk, both indirectly by increasing the risk of diabetes and directly through other mechanisms.


  1. Coronary heart disease risk and impaired glucose tolerance. The Whitehall study; The relationship of abnormal circulating insulin levels to atherosclerosis; Diabetes and atherosclerosis – the role of insulin; Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations; Relationship of glucose tolerance and plasma insulin to the incidence of coronary heart disease: Results from two population studies in Finland; Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease mortality in a middle-aged population; Insulin resistance and risk of incident cardiovascular events in adults without diabetes: Meta-analysis 
  2. Blood glucose and atherosclerosis; Atherosclerosis in persons with hypertension and diabetes mellitus; Status of the coronary arteries at necropsy in diabetes mellitus with onset after age 30 years; Morbidity and mortality in diabetics in the Framingham population 
  3. Dietary sucrose and platelet behavior
  4. Isocaloric exchange of dietary starch and sucrose in humans. Effect on fasting blood insulin, glucose and glucagon and on insulin and glcuose response to a sucrose load; Consuming fructose-sweetened, but not glucose-sweetened, beverages increases visceral adiposity and lipdis and decreases insulin sensitivity in overweight/obese humans; Added sugar intake and cardiovascular disease mortality among US adults
  5. Impaired glucose tolerance, but not impaired fasting glucose is associated with increased levels of coronary disease risk factors; Prevalence of unsuspected glucose intolerance in CAD patients: Importance of HbA1c

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