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Possible link between artificial sweeteners and heart disease

A large study of French adults published in The BMJ suggests a potential direct association between higher artificial sweetener consumption and increased cardiovascular disease risk, including heart attack and stroke. Artificial sweeteners represent a $7200 million global market. Researchers drew on data for 103 388 participants (average age, 42 years; 80% female) of the web‐based NutriNet‐Santé study, launched in France in 2009 to investigate relations between nutrition and health. Dietary intakes and consumption of artificial sweeteners were assessed by repeated 24‐hour dietary records, and a range of potentially influential health, lifestyle and sociodemographic factors were taken into account. Artificial sweeteners from all dietary sources (beverages, tabletop sweeteners, dairy products, etc) and by type (aspartame, acesulfame potassium, and sucralose) were included in the analysis. In total, 37% of participants consumed artificial sweeteners, with an average intake of 42.46 mg/day, which corresponds to approximately one individual packet of tabletop sweetener or 100 mL of diet soda. Among participants who consumed artificial sweeteners, mean intakes for lower and higher consumer categories were 7.46 and 77.62 mg/day, respectively. During an average follow‐up period of 9 years, 1502 cardiovascular events occurred. These included heart attack, angina, angioplasty, transient ischemic attack, and stroke. 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). Artificial sweeteners were more particularly associated with cerebrovascular disease risk (absolute rates, 195 and 150 per 100 000 person‐years in higher consumers and non‐consumers, respectively). Aspartame intake was associated with increased risk of cerebrovascular events (186 and 151 per 100 000 person‐years in higher consumers and non‐consumers, respectively), while acesulfame potassium and sucralose were associated with increased coronary heart disease risk (acesulfame potassium: 167 and 164 per 100 000 person‐years; sucralose: 271 and 161 per 100 000 person‐years in higher consumers and non‐consumers, respectively). This was an observational study, so could not establish cause, nor could the researchers rule out the possibility that other unknown (confounding) factors might have affected their results.