German researchers at Charité University Hospital in Berlin have linked high blood levels of the sweetener xylitol to a 57 per cent higher risk of heart attack.
The team analysed medical data from 17,710 participants over 30 years to examine whether the additive increases long-term cardiovascular risks among regular consumers of sugar-free chewing gum and mints.
Researchers found that participants with the highest circulating levels of xylitol in their blood faced a significantly greater likelihood of experiencing a heart attack, stroke, or premature death compared with those having the lowest levels.
Over a six-year follow-up period, the risk of suffering a major cardiovascular event remained 57 per cent higher among those who consumed the most xylitol, even after adjusting for established cardiovascular risk factors including age, sex, smoking status, and high blood pressure.
Data tracking participants over 30 years showed that the risk of heart attack, stroke, or heart death was 18 per cent higher in individuals with the highest blood levels of the sweetener, leading researchers to conclude that higher xylitol blood levels pose a greater risk to heart health.
Previous research has suggested that large quantities of xylitol can make blood thicker and stickier, increasing the likelihood of dangerous blood clots forming in the body.
Long-term cardiovascular risks
Dr Marco Witkowski, the author of the study from Charité University Hospital, presented the findings at the annual congress of the European Society of Cardiology.
Dr Witkowski noted that previous research had already shown individuals with high blood levels of the sweetener were more likely to suffer a heart attack or stroke within three years.
Addressing the widespread use of additives, Dr Witkowski stated that "artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies." He added that the findings demonstrate "how little we know" about the long term safety of the additives.
Independent medical experts who were not involved in the research stated that the findings highlight the need for further investigation into this "important topic".
Professor Dan Atar, a member of the European Society of Cardiology Communication Committee, commented on the study findings. Professor Atar said: "Artificial sweeteners are widely embraced by modern society, and their safety ratings have traditionally been considered good by regulatory authorities. In this observational work, however, it appears that xylitol has a negative long-term effect on cardiovascular events."
Properties and dental health benefits of xylitol
Xylitol is a naturally occurring sugar alcohol produced within the human body, but it is also widely manufactured as a food additive. Companies add it to foods, beverages, and oral care products because it provides sweetness with fewer calories than conventional sugar.
The substance is also recognised for having benefits for dental health by reducing the growth of bacteria that cause cavities and helping protect against tooth decay. However, medical researchers noted that its long-term impact on cardiovascular health has been widely overlooked until now.
Wider research into artificial sweeteners
The findings contribute to a growing body of scientific research linking artificial sweeteners to broader health concerns, including diabetes, obesity, and cancer.
Earlier this year, researchers from the University of Cambridge found that artificial sweeteners could slow the growth of beneficial gut bacteria, potentially increasing the risk of disease.
Health concerns have also extended to other artificial sweeteners. A 2025 study published in the journal Science Signaling found that sorbitol, an additive used in sugar-free sweets and ice cream, can cause fat to build up in the liver. This buildup increases the likelihood of liver disease, which is a major risk factor for liver cancer.
In 2023, the World Health Organisation controversially classified the artificial sweetener aspartame, which is used in soft drinks such as Diet Coke, as "possibly carcinogenic to humans". However, the United Nations agency clarified that aspartame only posed a risk to individuals consuming massive amounts, noting that an 11-stone or 70kg adult could safely consume about 14 cans per day.
Medical experts emphasize that potential health risks linked to artificial sweeteners must be carefully weighed against the well-established health harms associated with the sugar they replace.
Cardiovascular disease statistics
Cardiovascular disease remains the leading cause of death in the United Kingdom, where around 200,000 people suffer a heart attack or stroke each year.
An estimated eight million people in the United Kingdom are currently living with cardiovascular disease, a group of conditions affecting the heart and blood vessels. Around 100,000 Britons suffer a stroke each year, making it one of the nation's leading causes of death and claiming approximately 34,000 lives annually.
