Research Press Release

Health: Artificial sweetener may be linked to cardiovascular disease events

Nature Medicine

February 28, 2023

A commonly used artificial sweetener — erythritol — may be linked to cardiovascular disease events, a study in Nature Medicine suggests.

Artificial sweeteners are used in foods and beverages to reduce sugar and calorie intake. They are often advised as an alternative to sugar for people with metabolic diseases, such as diabetes and heart disease. They are generally considered safe by regulatory agencies, but little research has been conducted into their long-term health effects. Erythritol, a commonly used sugar substitute, is poorly metabolized by the body. It is naturally made, and found in low levels in fruit and vegetables but is added at higher levels to processed foods.

Stanley Hazen and colleagues conducted initial studies in 1,157 people undergoing cardiac risk assessments, with 3 years of outcome data. By analyzing the chemicals present in blood, the authors observed that levels of multiple compounds that looked like artificial sweeteners, in particular erythritol, were associated with an increased future risk of heart attack and stroke over three years of follow up. The associations were confirmed in independent cohorts undergoing elective cardiac evaluation in the United States (n = 2,149) and Europe (n = 833). The authors performed further studies showing addition of erythritol to whole blood, or platelets, led to accelerated clot generation, which were confirmed in animal model studies. The authors also conducted a prospective intervention study with eight healthy volunteers. They examined the plasma levels after they consumed 30 g of an erythritol-sweetened drink and found sustained increases in erythritol levels above thresholds noted to increase clotting risks for 2-3 days in all volunteers.

The authors suggest that their findings may indicate a link between elevations in erythritol levels and heightened clotting risk. However, they note that because the cohorts studied have a high prevalence of cardiovascular risk factors, whether similar results are observed in apparently healthy subjects monitored for longer periods of follow up remains to be determined.


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