Artificial sweeteners associated with increased risk of heart attack and stroke

Higher artificial sweetener consumption is associated with an increased risk of heart attack and stroke, according to a large study published in The BMJ.

While several studies have linked the consumption of artificial sweeteners to weight gain, high blood pressure, and inflammation, research about the role of artificial sweeteners in the cause of cardiovascular disease remained limited.

To investigate this further, a team of researchers at the French National Institute for Health and Medical Research (Inserm) and colleagues looked at data from more than 100,000 participants.

High consumers of artificial sweeteners tended to be young and have a higher BMI

The researchers drew on data from the web-based The NutriNet-Santé Study, launched in France in 2009 to investigate relations between nutrition and health.

Artificial sweeteners from all dietary sources (beverages, table top sweeteners, dairy products, etc) and by type (aspartame, acesulfame potassium, and sucralose) were included in the analysis.

Around two in five (37%) of participants consumed artificial sweeteners, with an average intake of 42.46 mg/day (approximately one individual packet of table top sweetener or 100 mL of diet soda).

Higher consumers tended to be younger have a higher body mass index, were more likely to smoke, be less physically active, and to follow a weight loss diet.

They also had lower total energy intake, and lower alcohol, saturated and polyunsaturated fats, fibre, carbohydrate, fruit and vegetable intakes, and higher intakes of sodium, red and processed meat, dairy products, and beverages with no added sugar. However, the researchers took account of these differences in their analyses.

Sucralose was associated with highest increase in coronary heart disease risk

The participants were followed up for an average of nine years. During this time, 1,502 cardiovascular events occurred including heart attack, angina, angioplasty (a procedure to widen blocked or narrowed arteries to the heart), transient ischemic attack and stroke.

Overall, total artificial sweetener intake was associated with an increased risk of cardiovascular disease (absolute rate 346 per 100,000 person years in higher consumers and 314 per 100,000 person years in non-consumers).

When looking at specific artificial sweeteners and their risks, the researchers found:

Aspartame intake was associated with increased risk of cerebrovascular events:

High consumers	Non-consumers
186 per 100,000 person years	151 per 100,000 person years

Acesulfame potassium was associated with increased coronary heart disease risk:

High consumers	Non-consumers
167 per 100,000 person years	164 per 100,000 person years

Sucralose was associated with increased coronary heart disease risk:

High consumers	Non-consumers
271 per 100,000 person years	161 per 100,000 person years

Artificial sweeteners should not be considered a healthy and safe alternative to sugar

While the study cannot establish a cause, they state that it a large study with high quality dietary data, and the findings are in line with other studies linking exposure to artificial sweeteners with several markers of poor health.

For this reason, the researchers say that these food additives should be considered a healthy and safe alternative to sugar.

Artificial sweeteners are widely used as no or low calorie alternatives to sugar by millions of people and they suggest that this study provides key insights into the context of artificial sweetener re-evaluation currently being carried out by the European Food Safety Authority, the World Health Organization, and other health agencies.