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That sugar-free gum might come with a hidden cost. A large study of over 17,000 people found that high blood levels of xylitol — a popular sweetener found in many "healthy" processed foods — were independently linked to a significantly higher risk of major cardiovascular events like heart attack and stroke, even after accounting for traditional risk factors like diabetes, BMI, and blood pressure.
Think xylitol is a safe swap for sugar? New research presented at the European Society of Cardiology (ESC) Congress 2026 in Munich suggests otherwise. A study of 17,710 participants across two large real-world cohorts found that people with the highest blood levels of xylitol faced a significantly elevated risk of major adverse cardiovascular events (MACE) — including death, heart attack, and stroke — compared to those with the lowest levels. Crucially, this risk held up even after adjusting for age, sex, BMI, blood pressure, diabetes, and lipid levels.
The findings build on earlier work showing xylitol can enhance platelet reactivity and accelerate clot formation in animal models — a plausible biological mechanism for the observed cardiovascular harm. Researchers also noted a dose-response pattern: the higher the xylitol level, the greater the cardiac risk.
By the Numbers:
Why it matters: Xylitol is increasingly common in sugar-free and "natural" food products, and many consumers assume it's a heart-healthy alternative to sugar. These findings challenge that assumption and add to a growing body of evidence — alongside similar concerns about erythritol — that not all sweeteners are cardiovascular-neutral. Clinicians may want to start factoring sweetener consumption into patient counseling, while researchers call for more targeted studies.
