Study Links Higher Blood Xylitol Levels to Increased Cardiovascular Risk
Researchers observed that participants with the highest concentrations of the artificial sweetener xylitol had a greater incidence of heart attack, stroke and cardiovascular death, prompting calls for further investigation.
Researchers presented data at the ESC Cardiology Congress in Germany indicating that elevated blood levels of xylitol, a sugar-alcohol sweetener, are associated with a higher risk 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 combined risk of cardiovascular death, myocardial infarction or stroke compared with those at the lowest levels. In the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort, the highest xylitol levels corresponded to an 18% higher risk of MACE over a 30-year period. Both studies reported a dose-response relationship that persisted after adjustment 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 of Charité University Hospital, who presented the findings. "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."
The investigators noted that the study is observational and cannot establish causality, and that blood xylitol may also arise from endogenous metabolic processes. Independent cardiologists cited the results as a reason to re-evaluate the use of artificial sweeteners, but no regulatory changes were reported.
The study adds to earlier laboratory work suggesting that xylitol can enhance platelet aggregation, a potential mechanism for increased clot formation. Researchers emphasized the need for additional clinical trials to confirm the association and to determine whether dietary intake directly drives the observed blood concentrations.