Health
Study Links Common Sweetener Xylitol to Higher Risk of Heart Attack and Stroke
New research presented at the European Society of Cardiology Congress 2026 suggests that xylitol, a widely used low-calorie sweetener, may be associated with an increased risk of major cardiovascular events, including heart attacks and strokes.
Xylitol is a sugar alcohol commonly added to processed foods, drinks, sugar-free chewing gum, and toothpaste to provide sweetness without the calories or tooth-decay risks of sugar.
The study was led by Dr. Marco Witkowski of Charité University Hospital in Berlin, Germany, who had previously shown that xylitol can enhance platelets' ability to form clots and that high blood levels of the sweetener were linked to cardiovascular events in high-risk individuals over a three-year period. The new research aimed to determine whether xylitol could also raise cardiovascular risk in the general population.
Researchers analyzed data from two large observational studies: the Canadian Longitudinal Study on Aging (CLSA), which tracked participants for six years, and the European Prospective Investigation into Cancer (EPIC)-Norfolk study, which followed participants for 30 years. Combined, the studies included 17,710 participants with an average age of 60.9 years.
After adjusting for traditional cardiovascular risk factors such as age, smoking, diabetes, and high blood pressure, participants were divided into four groups based on blood xylitol levels. The results showed that those with the highest xylitol levels faced a significantly greater risk of heart attack, stroke, or cardiovascular death compared to those with the lowest levels.
In the CLSA study, individuals with the highest xylitol levels had a 57% greater risk of a major adverse cardiovascular event (MACE) over the six-year period. In the EPIC-Norfolk study, the risk was 18% higher among those with the highest levels over 30 years. When combined, the data revealed a dose-dependent relationship, meaning cardiovascular event rates rose along with xylitol levels. This link remained even after accounting for factors such as body mass index, diabetes, and high blood pressure.
Witkowski said the findings highlight how little is known about the long-term cardiovascular safety of xylitol, adding that further studies are needed, particularly as its use in consumer products continues to grow.
Dan Atar, a member of the European Society of Cardiology Communication Committee, noted that although artificial sweeteners are widely used and considered safe by regulators, this observational study suggests xylitol may have a negative long-term effect on cardiovascular health in the general population.
Stanley Hazen, MD, PhD, of the Cleveland Clinic, who was not involved in the study, said growing evidence indicates that sugar alcohols like xylitol and erythritol may not be safe sugar substitutes. He said he now advises patients, especially those with or at risk of cardiovascular disease, to avoid these sweeteners due to their potential to increase clotting risk.
Cheng-Han Chen, MD, an interventional cardiologist at MemorialCare Saddleback Medical Center in California, also not involved in the research, recommended choosing naturally sweet foods like whole fruit when possible, since they provide fiber and other nutrients along with sweetness. He noted that artificial sweeteners can still serve a purpose for people with diabetes because they cause smaller blood sugar spikes than sugar, but cautioned that avoiding a glucose spike does not necessarily mean these sweeteners are healthy overall.
Both experts emphasized that since the study was observational, it cannot prove that xylitol directly causes heart attacks or strokes—only that an association exists. Chen said the findings should encourage more caution rather than an assumption that artificial sweeteners are always a healthier option, and called for further prospective studies and clinical trials to clarify any cause-and-effect relationship. Hazen added that more preclinical research, including animal studies, is needed, noting that existing evidence already supports a link between xylitol intake and increased platelet activity and clotting potential.