Study Links High Xylitol Levels to Increased Cardiovascular Risk
Researchers found that adults with the highest blood concentrations of the sweetener xylitol faced a 57% higher risk of heart attack, stroke or death over six years compared with those with the lowest levels.
A long-term analysis of 17,710 adults reported by the European Society of Cardiology found that participants with the highest blood levels of the sugar substitute xylitol experienced a 57% greater risk of heart attack, stroke or death over a six-year period than those with the lowest levels. The association persisted after adjusting for smoking, cholesterol, diabetes, hypertension, age and sex.
The researchers examined two large observational cohorts. In a Canadian sample, the high-versus-low xylitol comparison produced the 57% risk increase over six years, while a British cohort (EPIC-Norfolk) showed an 18% rise in major cardiovascular events over 30 years. Both studies demonstrated a dose-response pattern, with event rates rising alongside blood xylitol concentrations.
"In previous studies, we showed that xylitol can enhance the ability of platelets to form clots," said Dr. Marco Witkowski of Charité University Hospital, who presented the findings. "Here we studied if xylitol increases cardiovascular events in a larger sample of the general population over much longer follow-up."
Xylitol occurs naturally in small amounts in the body and certain foods, but manufacturers add larger quantities to sugar-free gum, candy, baked goods, toothpaste, mouthwash, cough syrup, chewable vitamins, supplements and some nut butters, according to the U.S. Food and Drug Administration. The agency advises consumers to check ingredient lists for the sweetener’s name.
"As with all observational studies, causalities are difficult to infer, but this work shows that further studies are mandated into this societally important topic," said Professor Dan Atar of the ESC.
"The findings highlight how little we know about the cardiovascular safety of xylitol and indicate that further studies are warranted," added Dr. Witkowski.
The authors caution that the results do not prove that consuming xylitol causes cardiovascular events, but they suggest a need for additional research into its long-term safety.