Artificial sweetener xylitol associated with higher risk of adverse cardiovascular events

A study to be presented at ESC Congress 2026 will show that high blood levels of the artificial sweetener, xylitol, were associated with increased risk of major adverse cardiovascular events.

Artificial sweeteners are widely used to replace dietary sugar. Xylitol is a sugar alcohol that occurs naturally in the body as a byproduct of glucose metabolism and is present in some natural foods in very low amounts. Xylitol is also added – often in over 1,000-fold higher amounts – to artificially sweeten foods, beverages and oral care products. Despite its growing use, the long-term impact of xylitol on cardiovascular event risk has not been widely studied. 

In previous studies, we showed that xylitol can enhance the ability of platelets to form clots. We also found that high blood levels of xylitol were linked to cardiovascular events in high-risk individuals over a 3-year period. Here we studied if xylitol increases cardiovascular events in a larger sample of the general population over much longer follow-up." 

Doctor Marco Witkowski, presenter, Charité University Hospital, Berlin, Germany

The research team looked at data from 17,710 participants in two prospective observational cohorts: the Canadian Longitudinal Study on Aging (CLSA) and the European Prospective Investigation into Cancer (EPIC)-Norfolk.

People with xylitol levels in the highest quartile were observed to have substantially higher risk of major adverse cardiovascular events (defined as death, myocardial infarction or stroke) than those with xylitol levels in the lowest quartile. 

Over a follow-up period of 6 years, the risk of a major adverse cardiovascular event was 57% higher in those with the highest levels vs. the lowest levels in the CLSA cohort after correcting for known cardiovascular risk factors (including age, sex, smoking status, lipid levels, diabetes and hypertension). 

Over a follow-up period of 30 years, the risk of major adverse cardiovascular events was 18% higher in those with the highest levels vs. the lowest levels in the EPIC-Norfolk cohort. 

Taken together with data from the middle quartiles, the results from both cohorts suggested a dose-dependent relationship: the higher the xylitol blood levels, the higher the cardiovascular event rate. 

Furthermore, the researchers showed that there was consistent increase in cardiovascular events with xylitol irrespective of baseline characteristics, such as age and sex. Doctor Witkowski also highlighted that the association was independent of underlying factors such as body mass index, hypertension, diabetes and lipid levels, which might predispose people to low-calorie products. 

"Artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies," noted Doctor Witkowski. "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," he concluded. 

Commenting on the findings, Professor Dan Atar, Member of the ESC Communication Committee, said: "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."