A large new study presented at a major European cardiology conference has found that higher blood levels of xylitol, a popular sugar substitute used in gum, candy, baked goods and dental products, are associated with an increased risk of heart attack, stroke and death, adding fresh evidence to a growing body of research questioning the sweetener's long-term cardiovascular safety.

The findings were presented at the European Society of Cardiology Congress in Germany in late August. Researchers analyzed data from more than 17,700 participants across two large, long-running studies: the European Prospective Investigation into Cancer, or EPIC, Norfolk cohort in the United Kingdom, and the Canadian Longitudinal Study on Aging, or CLSA.

In the Canadian cohort, participants with the highest blood xylitol levels showed a 57% higher risk of experiencing a major adverse cardiovascular event, defined as death, heart attack or stroke, over a six-year follow-up period, compared with those who had the lowest xylitol levels. In the British cohort, followed over a considerably longer 30-year period, participants with the highest xylitol levels showed an 18% greater risk of a major cardiovascular event compared with those with the lowest levels.

Dr. Marco Witkowski of Charité University Hospital in Berlin, who presented the research, said the findings underscore how little is currently understood about the long-term cardiovascular effects of a sweetener widely regarded as a healthier alternative to sugar.

"Artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies," Witkowski said. "Our long-term findings in the general population highlight how little we know about the cardiovascular safety of xylitol and........

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