High blood levels of xylitol, a widely used artificial sweetener, have been linked with a higher long-term risk of heart attack, stroke and death in a large observational study presented at ESC Congress 2026.
“People with the highest xylitol levels had a 57% higher risk of a major cardiovascular event after researchers accounted for factors including age, sex, smoking, cholesterol levels, diabetes and high blood pressure”
Researchers analysed data from 17,710 people taking part in two long-running population studies: the Canadian Longitudinal Study on Aging and the European Prospective Investigation into Cancer-Norfolk study.
Xylitol is a sugar alcohol produced naturally in small amounts by the body during glucose metabolism. It is also found at low levels in some foods. However, it is increasingly added to sugar-free foods, drinks and oral-care products, often at much higher concentrations.
The study found that participants with xylitol blood levels in the highest quarter had a greater risk of major adverse cardiovascular events — defined as death, heart attack or stroke — than those in the lowest quarter.
In the Canadian cohort, followed for six years, people with the highest xylitol levels had a 57% higher risk of a major cardiovascular event after researchers accounted for factors including age, sex, smoking, cholesterol levels, diabetes and high blood pressure.
In the EPIC-Norfolk cohort, which followed participants for up to 30 years, those with the highest xylitol levels had an 18% higher risk than those with the lowest levels.
The findings also suggested a dose-related pattern. Cardiovascular event rates rose as blood xylitol levels increased. The association was seen across age and sex groups and remained after accounting for body mass index, diabetes, hypertension and blood lipid levels.
Dr Marco Witkowski of Charité University Hospital in Berlin said previous research had suggested xylitol may make platelets more likely to form clots. He said the new findings add to concerns about the long-term cardiovascular safety of the sweetener.
“Artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies,” Dr Witkowski said. “Our long-term findings in the general population highlight how little we know about the cardiovascular safety of xylitol.”
Professor Dan Atar, a member of the European Society of Cardiology Communication Committee, said the research could not prove that xylitol directly caused cardiovascular events because it was observational.
However, he said the results support the need for further research into the potential health effects of artificial sweeteners as their use continues to grow.
