High blood levels of the sugar substitute xylitol are linked to an increased risk of heart attack and stroke, researchers reported at ESC Congress 2026.
The findings also associated elevated concentrations of the sweetener in the bloodstream with a higher overall risk of death from cardiovascular causes.
Researchers analysed data from 17,710 participants enrolled in two major long-term studies conducted in Canada and Europe. Across both groups, individuals with the highest blood levels of xylitol experienced significantly more major cardiovascular events than those with lower levels.
In the Canadian study cohort, participants in the highest xylitol concentration tier had a 57 percent higher risk of severe cardiovascular events over a six-year observation period. In the European cohort, the risk was 18 percent higher over 30 years of follow-up, with higher xylitol levels consistently matching increased rates of heart attack, stroke, and death.
Cardiovascular risk factors
The observed connection between xylitol and cardiovascular disease remained significant even after controlling for traditional risk factors. Researchers reported that age, sex, body mass index, diabetes, high blood pressure, cholesterol levels, and other health metrics did not account for the elevated risk.
The study authors highlighted that earlier laboratory work had already demonstrated xylitol's potential to increase blood clot formation by enhancing the activity of blood platelets.
Sugar substitute safety
Xylitol is a naturally derived sugar alcohol commonly used as a low-calorie alternative to sugar in food and oral care products, including sugar-free chewing gum, candies, baked goods, and toothpaste. ESC Congress 2026 is an international cardiovascular medicine conference organized annually by the European Society of Cardiology.
The study was observational in nature and does not establish a direct cause-and-effect relationship between xylitol consumption and cardiovascular events. However, the research team stated that the results demonstrate a clear need for further investigation into the safety of the widely used sweetener.
