Our findings suggest a higher-dose threshold for harmful association for added sugars compared with the current recommendations, implying that different food sources may differently contribute at different doses. Our certainty in the estimates is generally weak, and further research is very likely to change the estimates. Sucrose did not show an adverse association with CVD mortality, and there was no association of fructose-containing sugars of any type with CVD incidence. Our systematic review and dose-response meta-analysis of the available prospective cohort studies show a nonlinear dose-response association with CVD mortality for reported intakes of total sugars, fructose, and added sugars with thresholds for harm at high levels of intake. No harmful association was seen at lower intakes of these sugars or at any dose for sucrose with the relationship between sucrose and CVD mortality best explained by an inverse linear dose-response gradient in which 50 grams (10% energy) increase in sucrose was associated with a 7% reduction in CVD mortality. A harmful association of total sugars, fructose, and added sugars with CVD mortality was seen in nonlinear dose-response models with a threshold for harm above intakes of 133 grams (26% energy) for total sugars, 58 grams (11% energy) for fructose, and 65 grams (13% energy) for added sugars. Total sugars, sucrose, and fructose were not associated with CVD incidence in extreme quantile analyses or in linear and nonlinear dose-response models. We conducted a systematic review and dose-response meta-analysis of 10 unique prospective cohort studies (24 cohort comparisons) in 624,128 individuals involving 11,856 cases of CVD incidence and 12,224 cases of CVD mortality of the relation of total and added fructose-containing sugars with CVD risk.

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