Sugar vs Cholesterol: What Matters Most for Heart Health?
- JDR Nutrition
- Aug 18
- 3 min read
Updated: 6 days ago
For many years cholesterol was considered the main culprit in heart disease. Public health messages focused heavily on lowering dietary cholesterol and saturated fat to protect cardiovascular health. However, more recent research has questioned whether cholesterol is truly the strongest predictor of heart disease outcomes. Increasingly, evidence points towards added sugars, particularly in drinks and processed foods, as a significant risk factor for cardiovascular disease.
The role of sugar in heart disease
A large-scale 15-year study published in JAMA Internal Medicine followed US adults and examined their intake of added sugar. The findings were striking: individuals who consumed 25% or more of their daily calories from added sugar were over twice as likely to die from heart disease compared with those consuming less than 10%. This association was consistent across age, sex, weight, physical activity and even cholesterol levels. In other words, high sugar intake alone was enough to raise risk, regardless of other lifestyle factors.
So where is this sugar coming from? The biggest contributor is sugar-sweetened beverages such as fizzy drinks, fruit drinks and energy drinks. These are quickly absorbed, lead to blood sugar spikes and place a heavy burden on the liver. Over time, this can raise blood pressure and promote the release of harmful fats into the bloodstream.
UK and European evidence regards sugar vs cholesterol for heart disease
These findings are not limited to the United States. The UK Biobank, one of the largest ongoing health studies in the world, analysed data from nearly 110,000 people over nine years. Researchers found that for every 5% increase in daily energy intake from free sugars, the risk of heart disease rose by 6% and the risk of stroke rose by 10%. Sugar-sweetened drinks were the main driver of this increased risk, whereas natural sugars from fruit and dairy were not linked with the same outcomes.
Similar results have been observed in Europe. A Swedish study of almost 70,000 individuals found that higher consumption of sugar-sweetened drinks significantly increased the risk of stroke, atrial fibrillation, heart failure and aortic aneurysm. Again, the problem appeared to be concentrated in liquid sugar sources, not occasional sweet foods such as fruit or yoghurt.
Cholesterol & heart disease: the full picture
Cholesterol is still important to consider, but the relationship between cholesterol levels and heart disease is more complex than once thought. Several large reviews, including those published in the BMJ, have questioned whether lowering LDL cholesterol alone consistently reduces deaths from cardiovascular disease.
Many people who die from heart attacks do not actually present with high cholesterol levels.
What we see far more consistently is that high sugar intake leads to raised triglycerides, elevated blood pressure and chronic low-grade inflammation. These are all key drivers of cardiovascular disease and metabolic syndrome and may provide a better explanation for the rise in heart-related deaths than cholesterol alone.
Practical steps for protecting heart health
From a nutritional therapy perspective, the focus should be on long-term, sustainable habits that support cardiovascular health:
Reduce sugar-sweetened drinks. Replace fizzy drinks, squash and energy drinks with water, sparkling water with fruit, or unsweetened herbal teas.
Be aware of hidden sugars. Check food labels for added sugars in cereals, sauces, yoghurts and snacks.
Prioritise balanced meals. Combine protein, fibre and healthy fats to support steady blood sugar control.
Support triglyceride levels. Include sources of omega-3 fatty acids (oily fish, flax, chia, walnuts) and limit refined carbohydrates.
Think beyond cholesterol. While cholesterol still matters, focus equally on blood sugar balance, blood pressure and inflammation for a broader picture of heart health.
The bottom line
Heart health is not determined by cholesterol levels alone. Strong evidence from the US, UK and Europe shows that added sugar, especially in drinks, is closely linked with cardiovascular disease and premature death. By reducing intake of free sugars and focusing on whole, nutrient-dense foods, we can make a significant impact on heart disease risk.
Investing in preventative nutrition today means better long-term health and less time managing illness in the future.
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