Sugary beverages have made a bad name for themselves. They have been implicated in weight gain, obesity, tooth decay, insulin resistance, and an increase in the rate of type 2 diabetes. But is the alternative — beverages sweetened with artificial sweeteners — really any healthier? A new study suggests drinks sweetened without sugar may not be a better choice. It appears non-sugar sweeteners can increase your risk of heart disease as much as sugar-sweetened beverages.

Nearly half of all the added sugars that Americans consume come from sugar-sweetened beverages. While an occasional sugary drink isn’t harmful, consuming sugary drinks on a regular basis is associated with weight gain and a number of health problems, including type 2 diabetes.

People who were high consumers of both types of beverages had a greater risk of heart disease or stroke.

Beverages sweetened with artificial sweeteners are touted as a healthier alternative, but how these drinks affect health, cardiovascular health in particular, hasn't been known.

French researchers looked at what the health differences between drinking sugary beverages and artificially sweetened beverages might be. They studied 24-hour dietary records of nearly 105,000 people, using information collected in a French web-based study on the relationship between nutrition and health called the NutriNet-Santé cohort.

Participants’ beverage consumption was divided into sugary drinks and drinks sweetened with sugar substitutes. Soft drinks, fruit drinks and 100 percent juice were considered sugary beverages, while drinks sweetened with artificial sweeteners such as sucralose, aspartame and stevia were in the other category. The people in the study were then categorized as non-consumers, low consumers, or high consumers of sugary and artificially sweetened drinks, and followed for 10 years.

Nearly 1,400 people had some type of cardiovascular disease incident during follow-up, whether heart attack, stroke, transient ischemic attack or other cardiovascular problems.

When people who did not consume either sugary or artificially sweetened drinks were compared to those who did, people who were high consumers of both types of beverages had a greater risk of heart disease or stroke.

“Our study suggests artificially sweetened beverages may not be a healthy substitute for sugar drinks, and these data provide additional arguments to fuel the current debate on taxes, labeling and regulation of sugary drinks and artificially sweetened beverages,” said Eloi Chazelas, lead author of the study, in a statement.

Though the study proves an association between artificially sweetened beverages and cardiovascular diseases, it does not prove that they cause it. Regardless, health and nutrition experts generally agree that the regular use of artificially sweetened beverages is not part of a heart-healthy diet.

The safest bet is to make water your beverage of choice. It is the healthiest drink for all of us.

The research letter is published in the Journal of the American College of Cardiology.