Artificial sweeteners may increase risk for heart disease

Key Takeaways

• High intake of artificial sweeteners was linked to increased risks for cardiovascular, cerebrovascular and coronary heart disease.
• Researchers found no benefits to substituting added sugars for artificial sweeteners regarding CVD risk.

Greater consumption of artificial sweeteners was associated with a higher risk for cardiovascular, cerebrovascular and coronary heart disease, a study published in the BMJ found.

Acknowledging the known health risks that sugar poses to consumers, Charlotte Debras, a PhD candidate at Sorbonne Paris Nord University, and colleagues wrote that its healthier-in-theory alternative has been shown in previous studies to affect cardiovascular signals, including weight status, hypertension, inflammation, vascular dysfunction and gut microbiota.

“Most of these studies suggested adverse effects, and few suggested neutral or beneficial properties. Although the results were mixed, this literature generally supports a potential involvement of artificial sweeteners in cardiovascular health, with plausible mechanisms,” they wrote.

The potential association of artificial sweeteners and adverse cardiovascular effects are particularly relevant in the United States, where heart disease was the leading cause of death in 2020, accounting for 696,962 mortalities, according to the CDC. Stroke was the fifth-leading cause of death, with 160,264 mortalities.

Drawing data from 2009 to 2021, Debras and colleagues examined 103,388 participants —79.8% women with a median age of 42 years at baseline — from the French web-based cohort NutriNet-Santé. Participants were divided into three groups based on artificial sweetener intake:

• higher consumers (19,139, 18.51%), who consumed 77.62 mg daily;

• lower consumers (19,221, 18.59%), who consumed 7.46 mg daily; and

• non-consumers (65,028, 62.9%), who consumed 0 mg daily.

The participants provided 24-hour dietary recalls for 3 nonconsecutive days during the baseline period and then every 6 months thereafter. In addition to overall artificial sweetener intake, the researchers analyzed specific sweeteners (aspartame, acesulfame potassium and sucralose) and dietary sources.

Overall, 37.1% of participants reported consuming artificial sweeteners, with a daily intake of 42.46 mg. During a median follow-up period of 9 years, 1,502 total CVD incident events occurred.

Debras and colleagues found that total artificial sweetener intake was associated with a higher risk for CVDs, with an HR of 1.09 (95% CI, 1.01-1.18), while absolute incident rates per 100,000 person years were 346 and 314 for higher consumers and lower consumers, respectively.

Higher artificial sweetener consumers had a significantly greater risk for developing cerebrovascular disease than non-consumers (HR = 1.18; 95% CI, 1.06 to 1.31), according to the researchers. Cerebrovascular disease was also linked to higher intake of aspartame (HR = 1.17; 95% CI, 1.03-1.33), while higher intakes of acesulfame potassium (HR = 1.4; 95% CI, 1.06-1.84) and sucralose (HR = 1.31; 95% CI, 1-1.71) were associated with an increased coronary heart disease risk.

The researchers additionally found no benefits for substituting artificial sweeteners for added sugar for cardiovascular, cerebrovascular or coronary heart disease risk.

While further studies are needed to confirm the results and examine biological pathways, Debras and colleagues wrote that these sweeteners “consumed daily by millions of people and present in thousands of foods and beverages, should not be considered a healthy and safe alternative to sugar, in line with the current position of several health agencies.”

References:

• Debras C, et al. BMJ. 2022;doi:10.1136/bmj-2022-071204.
• Leading causes of death. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. Accessed Sept. 7, 2022.
• Study suggests possible link between artificial sweeteners and heart disease. https://www.eurekalert.org/news-releases/963879. Published Sept. 7, 2022. Accessed Sept. 7, 2022.