Study Links Higher Blood Xylitol Levels to Increased Cardiovascular Risk

Researchers presented data at the ESC Cardiology Congress in Germany indicating that elevated blood levels of xylitol, a sugar-alcohol used as a low-calorie sweetener, were associated with a higher incidence of major adverse cardiovascular events (MACE). The analysis combined two prospective cohorts comprising more than 17,700 adults from Canada and the United Kingdom. Over a six-year follow-up, participants in the Canadian Longitudinal Study on Aging with the highest xylitol concentrations experienced a 57% increase in the risk of cardiovascular death, myocardial infarction or stroke compared with those in the lowest quartile. In the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort, the highest xylitol levels corresponded to an 18% greater risk of MACE over a 30-year period. Both studies reported a dose-response relationship that persisted after adjusting for age, sex, body-mass index, hypertension, diabetes and lipid profiles.

"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, who presented the findings.

The investigators noted that the study was observational and could not establish causality, nor could it confirm that blood xylitol levels directly reflect dietary intake, as the compound is also produced endogenously during glucose metabolism. They recommended additional research to clarify the cardiovascular safety of xylitol, especially given its increasing use in foods, beverages, chewing gum and dental products.

Dr. Aseem Malhotra, a cardiologist not involved in the study, said the results warrant serious consideration and suggested that patients might benefit from reducing or eliminating artificial sweeteners as part of broader dietary changes.

Food and beverage industry groups were contacted for comment but did not respond at the time of publication.