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A new study presented at the European Society of Cardiology (ESC) Congress in Munich suggests that people with higher blood levels of xylitol—a popular artificial sweetener—may face an increased risk of major cardiovascular events, including heart attack and stroke. The findings were unveiled during the ESC Congress, which ran from Thursday, August 28 to Sunday, August 31 in Munich, Germany.
Researchers from Charité University Hospital in Berlin, led by Doctor Marco Witkowski, analyzed data from nearly 18,000 participants in two large observational studies: the Canadian Longitudinal Study on Aging (CLSA) and the European Prospective Investigation into Cancer (EPIC)-Norfolk. According to the ESC press release, participants with the highest blood levels of xylitol had a 57 percent greater risk of experiencing a major adverse cardiovascular event over a six-year period in the CLSA study, compared with those in the lowest group. In the EPIC-Norfolk cohort, which tracked participants for 30 years, those with the highest levels had an 18 percent higher risk than those with the lowest.
Xylitol is commonly used to replace sugar in foods, drinks, and oral care products. While it naturally occurs in small amounts in the body and some foods, it is added to products in much larger quantities. The researchers found that the risk of cardiovascular events appeared to rise as xylitol levels in the blood increased, showing a dose-dependent relationship. Importantly, this association was seen regardless of age, sex, body mass index, diabetes, hypertension, or cholesterol levels.
Doctor Witkowski noted, "Artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies. Our long-term findings in the general population highlight how little we know about the cardiovascular safety of xylitol and indicate that further studies are warranted, especially as the amount of xylitol in products continues to increase" (Newsweek).
The study also builds on previous research linking xylitol to increased blood clot formation, which can contribute to heart attacks and strokes. However, experts caution that these results come from observational studies, which can show associations but not direct causation.
Professor Dan Atar, a member of the ESC Communication Committee, commented, "Artificial sweeteners are widely embraced by modern society, and the safety ratings had been good and granted by regulatory authorities. In this observational work, however, it appears that xylitol has a negative long-term effect on cardiovascular events in the general population. As with all observational studies, causalities are difficult to infer, but this work shows that further studies are mandated into this societally important topic."
The researchers and commentators agree that more research is needed to fully understand xylitol's long-term effects on heart health. In the meantime, people who use artificial sweeteners, especially those with existing heart risk factors, are encouraged to discuss their choices with healthcare professionals.