Artificial Sweetener Xylitol Linked to Higher Risk of Cardiovascular Events

• A common artificial sweetener known as xylitol is associated with an increased risk of cardiovascular events.
• A new study found that the higher the level of xylitol in the blood, the greater the risk of heart attack and stroke.
• Xylitol is used to sweeten foods, beverages, and dental products, but the long-term health impacts of the sugar substitute are still being studied.

A common artificial sweetener, xylitol, may be detrimental to cardiovascular health.

A new study shows that higher levels of xylitol in the bloodstream were associated with higher risks of cardiovascular events like heart attack and stroke. 

The findings were presented at the European Society of Cardiology Congress 2026 in Munich, Germany, from August 28–31, but have not yet been published in a peer-reviewed scientific journal.

“Artificial sweeteners are consumed by people who think they are healthier than sugar, and they are generally regarded as safe by regulatory agencies,” Marco Witkowski, a researcher from the Charité University Hospital, Berlin, Germany, who presented the research, said in a news release.

“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 continued.

In previous research, Witkowski and colleagues demonstrated that xylitol increased the ability for platelets in the blood to form clots. They previously found that high blood concentrations of xylitol increased the risk of cardiovascular events among high risk individuals. 

Xylitol raises risk of cardiovascular events by up to 57%

For the new study, Witowski and colleagues explored how xylitol influences the risk of cardiovascular events among the general population. 

To do so, they examined data from more than 17,000 people in two different cohorts, one based in Canada and the other in the United Kingdom.

Among the participants, they found that those who had xylitol levels in the blood in the highest quartile had a significantly higher risk of stroke, myocardial infarction, and death when compared with participants who had xylitol blood levels in the lowest quartile. 

They found that in the Canadian cohort, across a follow-up period of six years, those with the highest levels of xylitol in the blood had a 57% higher risk of major adverse cardiovascular events than their peers with the lowest levels of xylitol in the blood.

This was the case even after correcting for other cardiovascular risk factors like hypertension, smoking status, age, and diabetes. 

In the U.K. cohort, over a follow-up period spanning 30 years, those with the highest levels of xylitol in the blood were found to have an 18% higher risk of major adverse cardiovascular events compared with those with the lowest level of xylitol in the blood. 

The researchers suggest that, when interpreted together, the findings from each cohort indicate a dose-dependent relationship between xylitol blood levels and the risk of cardiovascular events. The higher the blood xylitol level, the higher the risk of cardiovascular events. 

This association was independent of other factors that could affect the risk of cardiovascular events, such as hypertension, body mass index (BMI), and lipid levels. 

Are artificial sweeteners healthier than sugar?

The findings are the latest in a growing area of research examining the health impacts of artificial sweeteners. 

“We’ve traditionally viewed artificial sweeteners as a healthier alternative to sugar, particularly because they can reduce calorie and sugar intake,” said Cheng-Han Chen, MD, a board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA. Chen wasn’t involved in the study.

“But this study adds to a growing body of research raising questions about whether some artificial sweeteners may have unintended effects on cardiovascular health. It’s too early to say that artificial sweeteners cause heart attacks or strokes, but these findings suggest we shouldn’t automatically assume they’re the healthier choice,” Chen told Healthline.

“We also need to be careful about interpreting these findings. We don’t yet know whether simply reducing artificial sweetener consumption will lower a person’s risk of heart attack or stroke. More research, particularly well-designed clinical trials, is needed to determine whether there is a direct cause-and-effect relationship,” he continued.

What to know about xylitol

Artificial sweeteners have become a popular choice to replace sugar. Xylitol occurs naturally in the body and is a sugar alcohol that occurs as a byproduct of glucose metabolism. 

In manufacturing, it may be added to beverages, food, and dental products to artificially sweeten them. 

Yet the long-term health effects of xylitol remain a subject of ongoing research. 

Dana Hunnes, PhD, a senior dietitian at UCLA Health, said that small amounts of sugar may be preferable to artificial sweeteners. Hunnes wasn’t involved in the study.

“The more I learn about potential health detriments of artificial sweeteners, the more I’m convinced that sometimes a little bit of real sugar is not the devil that we are made to believe by the PR reps at protein companies,” she told Healthline.

“The fact is, too many people eat too much added sugar. However, small amounts of sugar or even added sugar can be OK and part of an otherwise healthy diet. It’s best to stick with small amounts of real sugar in place of artificial sweeteners,” she said.

Diet and lifestyle matter for heart health

Eleanor Levin, MD, a cardiologist at Stanford University, said that avoiding artificial sweeteners has less of an overall impact on heart health than making other dietary changes. Levin wasn’t involved in the study.

“This is less important than other dietary modifications at this time that reduce LDL cholesterol, like the DASH diet, high in vegetables and legumes,” she told Healthline. 

Levin noted that despite ongoing research on artificial sweeteners, some people may still benefit from reducing their sugar intake. 

“For prediabetics and diabetics, it is best to avoid sugar, she said.

“That said, more observational data is suggesting that artificial sweeteners do not reduce cardiovascular risk. Prediabetes is very common in American adults, and it is wise to avoid sugar and reduce white carbs to reduce risk: potatoes, rice, noodles, and bread. ‘Brown’ carbs like tofu and shirataki noodles, brown rice, and sweet potatoes raise blood sugar less,” Levin continued.

The researchers noted that more studies are needed to determine the cardiovascular safety of artificial sweeteners like xylitol. 

Chen said that the best way to reduce the overall risk of adverse cardiovascular events is to focus on the basics. 

“When it comes to reducing cardiovascular risk, I recommend focusing on the fundamentals: eat a balanced, heart-healthy diet that is low in saturated fat, sodium, and added sugar; stay physically active; maintain a healthy weight; avoid tobacco; limit alcohol; and prioritize good-quality sleep,” he said. 

“Rather than focusing on whether one sweetener is ‘good’ or ‘bad,’ the goal should be an overall dietary and lifestyle pattern that supports heart health.”