Could Artificial Sweeteners Increase the Risk for Cardiovascular Disease?

A higher consumption of artificial sweeteners is associated with an increased risk for cardiovascular events such as coronary heart disease and cerebrovascular disease, according to study findings published in the British Medical Journal.

Researchers in France conducted a population-based, prospective, cohort study using the web-based NutriNet-Santé cohort, which assesses associations between nutrition and health. They selected 103,388 participants from this cohort (79.8% female; mean age, 42 years) and analyzed the relationship between artificial sweetener intake and risk for cardiovascular disease.

Participants completed 5 online questionnaires which assessed their 24-hour dietary intake, including artificial sweetener consumption, lifestyle data, demographics, personal and family medical history, occupation, and physical activity levels converted into metabolic equivalent of tasks (MET).

After baseline assessment, dietary intake questionnaires were randomly repeated at least 3 non-consecutive days over 2 weeks and progressing to every following 6 months for the next 2 years. These dietary records were averaged to calculate a baseline diet which indicated each participant’s consumption habits using a reliable method.

Throughout the follow-up period from the study inception until October 5, 2021, the researchers assessed incidence of cardiovascular disease events, including:

• coronary heart disease as evidenced by codes indicating myocardial infarctions, acute coronary syndrome, angioplasty, angina pectoris, and
• cerebrovascular disease as evidenced by codes indicating stroke and transient ischemic attacks.

The researchers obtained relevant supporting information for each cardiovascular event reported. Among the 103,388 participants, a total of 1502 cardiovascular events occurred during this period. A total of 37.1% participants consumed artificial sweeteners with the average intake of artificial sweeteners as 15.76 mg/day among all participants and 42.46 mg/day among consumers only.

Following analysis of dietary intake and incidence of cardiovascular events, the researchers found that total artificial sweetener intake positively correlated with increased risk for cardiovascular diseases (hazard ratio [HR]: 1.09; 95% CI, 1.01-1.18, P =.03).

Notably, artificial sweeteners contributed to the increased incidence for cerebrovascular events among consumers compared with non-consumers (777 events; incidence rates of 195 vs. 150 HR: 1.18; 95% CI, 1.06-1.31; P =.002). Aspartame especially correlated with increased incidence of cerebrovascular events in consumers compared with non-consumers (186 vs. 151 every 100,000 person-years; HR: 1.17; 95% CI, 1.03-1.33; P =.02).

Artificial sweeteners containing acesulfame potassium (incidence rates: 167 vs 164; HR: 1.40; 95% CI, 1.06-1.84, P =.02) and sucralose (incidence rates: 271 vs. 161; HR: 1.31; 95% CI, 1.00-1.71; P =.05) increased risk for coronary heart disease.

The researchers noted that their study suggests a potential direct association between a higher consumption of artificial sweeteners like aspartame, acesulfame potassium, and sucralose, and the risk for cardiovascular disease.

They concluded that “The results suggest that artificial sweeteners might represent a modifiable risk factor for cardiovascular disease prevention.”

Disclosure: Some study authors declared support of several national and international organizations for this study. Please see the original reference for a full list of authors’ disclosures.