Artificial sweetener consumption linked to increased cardiovascular disease risk

A web-based prospective cohort study conducted in France, results of the study indicate consumption of artificial sweeteners was associated with a 9% increase in risk of cardiovascular disease, with further analysis breaking down the risk observed by individual sweeteners, including aspartame, acesulfame potassium, and sucralose.

“In the NutriNet-Santé cohort, total artificial sweetener intake was associated with increased risk of overall CVD and cerebrovascular disease. Aspartame intake was associated with increased risk of cerebrovascular events, and acesulfame potassium and sucralose were associated with increased coronary heart disease risk. Our results suggest no benefit from substituting artificial sweeteners for added sugar on CVD outcomes,” wrote investigators.

Since the late 1990s and early 2000s, artificial sweeteners have increased in popularity as ultra-processed food and artificially sweetened beverages have become more common staples in diets across the globe. Conducted by a team from the University of Paris and the French Network for Nutrition and Cancer Research, investigators designed their population-based prospective cohort study to evaluate association between artificial sweeteners and risk of cardiovascular disease.

Launched in 2009, the NutriNet-Santé e-cohort was created with the intent of assessing relationships between nutrition and health. Hailed as the world’s largest nutrition study, the web-based cohort contains data related to more than 170,000 adults aged 15 years or older who completed online questionnaires about diet, health, anthropometric data, lifestyle and sociodemographic data, and physical activity. Overall, 103,388 participants were identified for inclusion in the current study. These patients had a mean age of 42.2±14.4 years, 79.8% were female, and had a total of 904,206 person-years of follow-up data.

Of those included, 37.1% reported consumption of artificial sweeteners, with an average intake of 15.76 mg per day among all participants and 42.46 mg per day among consumers. Investigators pointed out associations between sweeteners and cardiovascular risk were estimated using multivariable-adjusted Cox hazard models.

Upon analysis, results indicated total artificial sweetener intake was linked to an increased risk of cardiovascular disease (HR, 1.09 [95%CI, 1.01-1.18]; P=.03). Further analysis of individual sweeteners demonstrated consumption of aspartame was associated with an increased risk of cerebrovascular events (HR, 1.17 [95% CI, 1.03-1.33]; P=.02) while consumption of acesulfame potassium (HR, 1.40 [95% CI, 1.06-1.84]; P=.02) and sucralose (HR, 1.31 [95% CI, 1.00-1.71]; P=.05) were associated with increased risk of coronary heart disease.

“These findings suggest that higher artificial sweetener consumption might be associated with increased risk of CVDs. Further well-designed, large-scale prospective studies need to confirm these results and experimental studies should be conducted to clarify biological pathways. In the meantime, this study provides key insights into the context of artificial sweetener re-evaluation by the EFSA, WHO, and other health agencies worldwide,” investigators added. “Our results indicate that these food additives, 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.”

This study, “Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort,” was published in The BMJ.

This article originally appeared on Practical Cardiology®.