Marco Witkowski linked xylitol cardiovascular events to higher long-term risk after analyzing 17,710 participants in two prospective observational cohorts. The study, presented at the European Society of Cardiology Congress 2026 in Munich, found that people in the highest xylitol quartile had more major adverse cardiovascular events than those in the lowest quartile.
In the Canadian Longitudinal Study on Aging, the 6-year follow-up showed a 57% higher risk among participants with the highest xylitol levels. In the European Prospective Investigation into Cancer Norfolk cohort, the 30-year follow-up showed an 18% higher risk, extending earlier findings from patients with cardiovascular disease into the general population.
Marco Witkowski and 2024
Witkowski, a researcher at Charité University Hospital in Berlin, had already reported in 2024 that 1,157 stable patients with a history of cardiovascular disease had a significantly higher rate of serious cardiovascular events over the following 3 years when they had high blood concentrations of xylitol. His team later replicated that finding in a second cohort of 2,149 patients, and a small study of 10 healthy volunteers found that a xylitol-sweetened beverage increased blood markers consistent with greater platelet reactivity.
The new analysis took the question beyond patients already known to have cardiovascular disease. It tied higher blood xylitol levels to higher event rates across two large observational cohorts, and the association was consistent across subgroups without varying by baseline characteristics such as age or sex.
ESC Communications Committee
Dan Atar, a member of the ESC Communications Committee, said xylitol appears to be associated with a long-term adverse effect on cardiovascular events in the general population. He added that causal inferences cannot be made from the observational study and said, “Sweeteners are widely used in modern society, and their safety profiles have generally been regarded as acceptable by regulatory authorities. In this observational study, however, xylitol appears to be associated with a long-term adverse effect on cardiovascular events in the general population. As with all observational research, causal inferences cannot be made, but these findings clearly support the need for further study in an area of major public health importance.”
For now, the practical takeaway is narrow but direct: the highest blood xylitol levels were the group linked to higher risk, not a proven cause of events. The study raises the sharper question of what amount of xylitol exposure in consumer products corresponds to those blood levels, and that answer is still ahead of the data presented in Munich.
