Sugar-Free but Not Risk-Free? Exploring Artificial Sweeteners and Cardiovascular Disease

The consumption of artificial sweeteners has significantly increased globally, particularly as a substitute for sugar for the management of conditions such as diabetes and obesity, which are significant risk factors for cardiovascular disease. Despite their widespread use, the health impacts of artificial sweeteners remain contentious. Research has suggested that certain sweeteners may contribute to systemic inflammation, endothelial dysfunction, and disruptions in gut microbiota, potentially altering glucose metabolism and exacerbating metabolic conditions such as diabetes and obesity. However, other studies highlight potential benefits, such as weight control and improved glucose tolerance. Still, the long-term safety of artificial sweeteners, particularly with chronic consumption, remains uncertain. This literature review explores the cardiovascular risks associated with various artificial sweeteners, focusing on the 6 US Food and Drug Administration–approved nonnutritive sweeteners, aspartame, sucralose, saccharin, acesulfame K, cyclamate, and neotame, as well as nutritive sweeteners such as polyols (erythritol, xylitol, sorbitol, and maltitol). Ongoing research, including in vitro, animal, and clinical studies, aims to clarify the long-term cardiovascular and metabolic implications of artificial sweeteners and assess the safety of their widespread use across diverse populations.