A long-term analysis has revealed that high blood levels of common artificial sweetener, xylitol, can be associated with a greater risk of cardiovascular events within the general population, potentially placing the safety of its long-term, high consumption into question.
According to the research, which will first debut at the 2026 European Society of Cardiology Congress in Munich, individuals with high blood levels of xylitol – an ingredient commonly used in oral pharmaceutical products to improve taste – are at a “substantially higher” risk of major cardiovascular events such as heart attack or stroke.
Alongside its applications in certain medicines, the chemical is used in foods, beverages, and oral care products. The human body also produces small amounts of xylitol as a byproduct of carbohydrate metabolism.
The cardiovascular link, researchers say, is particularly profound when comparing risk in individuals with the highest and lowest levels of xylitol in their blood, as those in the top 25% for serum xylitol concentrations were 57% more likely to experience a major cardiovascular event over those in the lowest quartile during a follow-up period of six years. When obtaining this measure, researchers accounted for known cardiovascular risk factors such as age, sex, lipid levels, diabetes, smoking status and high blood pressure.
The xylitol-linked cardiovascular risk was also 18% higher at the 30-year mark in those with the highest levels of the sweetener compared with those who had lowest circulating levels.
When looking at the middle quartiles, researchers also uncovered a dose-dependent relationship that persisted regardless of an individual’s baseline characteristics – meaning that risk from high blood levels of xylitol still increased in people who didn’t have underlying cardiovascular risk factors like diabetes, high blood pressure or a high body mass index (BMI).
The research was conducted at Berlin’s Charité University Hospital, where the team looked at data from nearly 18,000 participants.
These findings build on prior research from the same team, which highlighted xylitol’s association with cardiovascular events in high-risk individuals over a three-year study period, claims study presenter and Charité University Hospital senior consultant, Dr Marco Witkowski. Previously, Witkowski and his colleagues also identified the artificial sweetener’s role in enhancing the capacity of platelets to form clots.
Xylitol’s increasing use brought into question
While global regulators largely regard xylitol as a food and drug-safe ingredient, Witkowski warns that the preliminary signs of its potential to boost cardiovascular risk raise some questions about its long-term impact on heart health.
“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,” commented Witkowski.
ESC communication committee member, Dan Atar, echoed Witkowski’s sentiments on the need for further research, adding that conclusions on causality can be challenging to obtain from observational studies such as the one Witkowski and his team have conducted.
While the use of xylitol surges within the food industry, pharma has also taken to using the sweetener as a non-active ingredient within oral dosage forms, with its applications extending into sweetening, as well as filling and binding ingredients within tablets and medicated confectionaries.
