New study links high blood Xylitol levels to increased risk of heart attack, stroke

New research presented at the European Society of Cardiology (ESC) Congress 2026 has raised fresh concerns about xylitol, with researchers reporting that people with higher levels of the sugar substitute in their blood may face an increased risk of major cardiovascular events.

The study, involving 17,710 people from two large prospective cohorts, found an association between elevated circulating xylitol and cardiovascular death, heart attack and stroke.

Researchers analysed participants from the Canadian Longitudinal Study on Ageing and the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk) study.

In the Canadian cohort, participants in the highest xylitol group recorded a 57 per cent higher risk of major adverse cardiovascular events after adjustment for established cardiovascular risk factors during six years of follow-up.

The European cohort, which had up to 30 years of follow-up, recorded an 18 per cent higher risk among those with the highest xylitol levels.

Researchers also observed a dose-response pattern, with cardiovascular event rates tending to increase as blood xylitol concentrations rose.

ESC senior member Dan Atar described the findings as important, saying xylitol appeared to have a negative long-term association with cardiovascular outcomes in the general population.

He called for further research into the issue, particularly because artificial sweeteners and sugar substitutes have become widely used in modern diets.

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Xylitol is a naturally occurring sugar alcohol used as a lower-calorie alternative to sugar. It is commonly found in sugar-free chewing gum, mints, confectionery and oral-care products.

Unlike high-intensity sweeteners such as aspartame and sucralose, xylitol provides sweetness while retaining some of the bulk and texture associated with conventional sugar.

It has also been widely promoted for dental health because it does not encourage tooth decay in the same way as ordinary sugar.

The new findings, however, add to concerns raised by an earlier 2024 study published in the European Heart Journal, which also associated higher circulating xylitol levels with cardiovascular-event risk.

Laboratory and animal experiments from the earlier research suggested that xylitol could increase platelet reactivity and promote thrombosis, while a small human experiment found increased platelet responsiveness following consumption of a xylitol-sweetened drink.

Despite the findings, researchers have stressed an important limitation: the new study is observational.

This means it establishes an association between blood xylitol levels and cardiovascular outcomes but does not prove that consuming xylitol directly caused heart attacks, strokes or deaths.

Higher xylitol levels could also reflect other dietary, metabolic or health-related factors that contribute to cardiovascular risk.

The findings therefore do not establish that consumers should immediately stop using xylitol-containing products.

Rather, researchers say the results warrant controlled clinical studies to determine whether xylitol itself contributes to cardiovascular disease and whether the amount or frequency of consumption influences risk.

The research is particularly significant because xylitol has traditionally been viewed as a relatively favourable sugar substitute because of its lower calorie content, limited effect on blood glucose and dental benefits.

The emerging cardiovascular evidence could therefore prompt scientists and regulators to reassess the long-term health implications of widespread xylitol consumption.

For now, experts caution that the findings should be interpreted carefully and should not be treated as proof of causation until further clinical research is completed.