Common Sugar Substitute Negatively Impacts Cardiovascular Risk

THURSDAY, March 9, 2023 (HealthDay News) -- Erythritol is associated with incident major adverse cardiovascular event risk and enhances platelet reactivity and thrombosis formation, according to a study published online Feb. 27 in Nature Medicine.

Marco Witkowski, M.D., from the Lerner Research Institute at the Cleveland Clinic, and colleagues examined the commonly used sugar substitute erythritol and atherothrombotic disease risk among patients undergoing cardiac risk assessment and healthy volunteers.

The researchers found that circulating levels of multiple polyol sweeteners, especially erythritol, were associated with incident risk for major adverse cardiovascular events in initial untargeted metabolomics studies in 1,157 patients undergoing cardiac risk assessment (discovery cohort). This association was confirmed in targeted metabolomics analyses in independent validation cohorts of stable patients (2,149 U.S. patients and 833 European patients) undergoing elective cardiac assessment (fourth versus first quartile adjusted hazard ratios, 1.80 and 2.21, respectively). Erythritol enhanced platelet reactivity in vitro and formation of thrombosis in vivo at physiological levels. In eight healthy volunteers, erythritol ingestion induced marked and sustained increases in plasma erythritol levels well above thresholds associated with heightened platelet reactivity and thrombosis potential.

"Our study shows that when participants consumed an artificially sweetened beverage with an amount of erythritol found in many processed foods, markedly elevated levels in the blood are observed for days -- levels well above those observed to enhance clotting risks," a coauthor said in a statement.

Several authors disclosed financial ties to the pharmaceutical industry; one author is a co-inventor on pending and issued patents held by the Cleveland Clinic relating to cardiovascular diagnostics and therapeutics. The LipidCardio Study was partially funded by Sanofi-Aventis.

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