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Artificial Sweeteners and Cardiovascular Disease: Systematic Review and Meta-analysis.

Sofía Gimeno-Ruiz1,2, Carolina Torrijo-Belanche1, Ainara Muñoz-Cabrejas3

  • 1Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, 50009, Spain.

Nutrition Reviews
|January 22, 2026
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Summary

Artificial sweeteners (AS) are popular for low-sugar diets, but their cardiovascular disease (CVD) link is debated. Elevated serum polyols show a higher CVD risk, but total AS consumption lacks clear association.

Keywords:
artificial sweetenerscardiovascular diseasemeta-analysissystematic review

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Area of Science:

  • Nutrition Science
  • Cardiovascular Research
  • Public Health

Background:

  • Artificial sweeteners (AS) are widely used as sugar substitutes, particularly in low-sugar diets recommended for cardiovascular disease (CVD) prevention.
  • Despite widespread consumption and perceived safety, the association between AS and cardiovascular health remains a subject of ongoing scientific debate.
  • This study addresses the controversial link between AS and CVD, focusing on direct measurements and dietary intake, excluding artificially sweetened beverages.

Purpose of the Study:

  • To systematically review and synthesize existing evidence on the association between artificial sweeteners (AS) and cardiovascular disease (CVD).
  • To specifically investigate the relationship between serum/plasma levels of AS and CVD outcomes.
  • To examine the association between dietary consumption of AS and CVD mortality and events, excluding studies on artificially sweetened beverages.

Main Methods:

  • A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus databases up to February 2025.
  • Data extraction followed PRISMA guidelines, with study characteristics and AS/CVD associations extracted by two independent reviewers.
  • Meta-analysis employed a random-effects model to estimate pooled hazard ratios, with heterogeneity assessed using I2 and publication bias evaluated via funnel plots and Egger's tests.

Main Results:

  • Meta-analysis of 6 studies on serum/plasma AS revealed a positive association for polyols, indicating a 26% higher risk of cardiovascular events when comparing extreme intake categories.
  • High heterogeneity and suspected publication bias were noted in the serum/plasma polyol analysis.
  • Systematic review of 5 studies on AS consumption showed mixed results for CVD mortality but generally positive associations for cardiovascular events, though limited by small sample sizes and focus on specific food products.

Conclusions:

  • Elevated serum/plasma polyol levels are significantly associated with an increased risk of cardiovascular events.
  • Current evidence does not establish a clear association between overall artificial sweetener consumption and cardiovascular disease mortality or events.
  • Further rigorous research is essential to elucidate the complex relationship between artificial sweetener intake and cardiovascular health.