Study Links High Blood Levels of Xylitol to Increased Cardiovascular Risk
Researchers presenting data at the European Society of Cardiology Congress 2026 found that participants with the highest blood concentrations of the sweetener xylitol faced a greater likelihood of heart attack, stroke or cardiovascular death.
Researchers analyzing data from the Canadian Longitudinal Study on Aging and the EPIC-Norfolk cohort reported that individuals with the highest quartile of blood xylitol levels experienced a significantly higher incidence of major adverse cardiovascular events than those with the lowest levels. In the Canadian cohort, followed for six years, the top-quartile group had a 57% higher risk after adjusting for age, sex, smoking, cholesterol, diabetes and hypertension. In the EPIC-Norfolk study, which spanned 30 years, the risk increase was 18% for the same comparison.
The investigators described a dose-response pattern, indicating that cardiovascular risk rose in proportion to blood xylitol concentrations, and noted that the association persisted across age, sex and body-mass-index categories.
"Artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies," said Dr. Marco Witkowski, presenter from Charité University Hospital in Berlin.
"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," Witkowski added.
Registered nutritionist Kirsty Thomas, who was not involved in the study, cautioned that the results should be viewed within the broader scientific literature and not lead to immediate dietary changes for people with diabetes or those reducing sugar intake.
"The results are noteworthy, however, especially for individuals at risk for cardiovascular disease. It's best to consult with a healthcare provider about dietary decisions and to think in terms of nutrition," Thomas said.
Professor Dan Atar of the ESC Communication Committee emphasized that, while artificial sweeteners have been deemed safe by regulators, the observational nature of the study precludes definitive conclusions about causality and underscores the need for further research.