Supplements · Sweeteners · Metabolic & Cardiometabolic
non-nutritive sweeteners increases cardiovascular disease
Part of: • non-nutritive sweeteners
📅 Last reviewed: 2026-07-15 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
How the studies fall
What the evidence shows
Cohort meta-analyses fairly consistently associate high artificially-sweetened-beverage intake with cardiovascular events and stroke — but the evidence is observational, heterogeneous, and confounded: a Women's-Health-Initiative network meta-analysis found no consistent pattern, umbrella reviews call it inconclusive, and bias-adjusted analyses flip toward benefit.
The evidence (10)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Beigrezaei S, Raeisi-Dehkordi H, Hernández Vargas JA, Amiri M, Artola Arita V, van der Schouw YT, Salehi-Abargouei A, Muka T, Chatelan A, Franco OH 2025 · Nutr Rev | meta-analysis | supports | moderate | Umbrella review re-pooling multivariable HRs of 50 primary prospective cohorts from 6 meta-analyses: per 250 mL/d NSSB, stroke 'HR: 1.09; 95% CI: 1.04 to 1.13', CHD '1.06; 95% CI: 1.02 to 1.11'; CV mortality 1.07 (1.00-1.15, not robust in leave-one-out). Observational associations; authors note magnitudes 'are not large'. |
| Debras C, Chazelas E, Sellem L, Porcher R, Druesne-Pecollo N, Esseddik Y, de Edelenyi FS, Agaësse C, De Sa A, Lutchia R, Fezeu LK, Julia C, Kesse-Guyot E, Allès B, Galan P, Hercberg S, Deschasaux-Tanguy M, Huybrechts I, Srour B, Touvier M 2022 · BMJ | observational | supports | moderate | NutriNet-Santé: artificial sweeteners (esp. aspartame, sucralose) associated with higher cardiovascular disease risk (coronary + cerebrovascular). |
| Meng Y, Li S, Khan J, Dai Z, Li C, Hu X, Shen Q, Xue Y 2021 · Nutrients | meta-analysis | supports | low | Dose-response MA of prospective cohorts: 'The summary RR for CVDs for each additional ASB serving per day was 1.08 (95%CI: 1.04–1.11)' from only four cohorts (I2 = 45.5%, non-linear); highest-vs-lowest 'a 17% higher risk of CVDs was shown in these cohorts (RR: 1.17; 95% CI: 1.06–1.29)'. All-cause mortality per serving was NULL — '7% (RR: 1.07, 95%CI: 0.91–1.25' — so the previous extract's mortality clause overstated the result. Quality low: the authors state that for ASBs 'the quality of the evidence is limited by potential bias and heterogeneity due to the design of the study'. |
| Qin P, Li Q, Zhao Y, Chen Q, Sun X, Liu Y, Li H, Wang T, Chen X, Zhou Q, Guo C, Zhang D, Tian G, Liu D, Qie R, Han M, Huang S, Wu X, Li Y, Feng Y, Yang X, Hu F, Hu D, Zhang M 2020 · Eur J Epidemiol | meta-analysis | supports | moderate | Dose-response MA of 39 prospective-cohort articles; ASB endpoints pooled were obesity, T2DM, hypertension and all-cause mortality only: 'and 6% (RR = 1.06, 95% CI 1.02-1.10, I2 = 80.8%) for all-cause mortality' (non-linear, Pnon-linearity = 0.048). No cardiovascular-disease endpoint was analysed, so this paper does not test the CVD claim. |
| Yang B, Glenn AJ, Liu Q, Madsen T, Allison MA, Shikany JM, Manson JE, Chan KHK, Wu WC, Li J, Liu S, Lo K 2022 · Nutrients | meta-analysis | mixed | moderate | WHI cohort + network MA: large between-study heterogeneity, no consistent pattern implicating ASB (or SSB/added sugar) in CVD outcomes. |
| Ayoub-Charette S, Kavanagh M, Khan T, Sievenpiper J 2025 · Appl Physiol Nutr Metab | meta-analysis | contradicts | high | Umbrella review, units are syntheses: 'we conducted an umbrella review of systematic reviews and meta-analyses.' 'We included six trial- and five cohort-based analyses.' Cohort analyses: LNCS associated with higher CV mortality in naive analyses but 'lower body weight, waist circumference, obesity, coronary heart disease, and cardiovascular and all-cause mortality in bias-adjusted analyses.' Review — zero weight. |
| Owu RT, Annan EE, Ainuson-Quampah J, Asante M, Brown CA, Asare GA 2025 · Journal of nutrition and metabolism | animal | supports | low | Rat model, 17wk. High-dose stevia group had highest Atherogenic Index of Plasma (0.21+/-0.07), dose-dependent increase; white sugar had highest Castelli Risk Index I/II. |
| Bhandari B, Zeng L, Grafenauer S, Schutte AE, Xu X 2024 · Curr Dev Nutr | meta-analysis | contradicts | low | Meta-analysis of prospective cohorts with repeated beverage measures; the ASB-CVD mortality estimate rests on only 2 cohorts (Malik 2019 NHS/HPFS; Ma 2023 NHS/HPFS adults with T2D), 131,134 adults / 10,293 CVD deaths for the SSB-or-ASB pool. Clean null for artificially sweetened beverages, highest vs lowest intake: pooled HR 1.05 (95% CI 0.87-1.26), P=0.61, I2=61%. Same pool found SSB HR 1.31 (1.16-1.46). Outcome is CVD mortality (not incident CVD); exposure is ASB, a proxy for NNS; the two cohorts share the Harvard NHS/HPFS populations. |
| Queiroz I, Defante MLR, Tavares A, Antunes V, de Mesquita CF, Barbosa LM, Mendes BX, Koh AS 2025 · Curr Probl Cardiol | meta-analysis | supports | moderate | MA: high ASB consumption associated with increased long-term cardiovascular events. |
| Narain A, Kwok CS, Mamas MA 2016 · Int J Clin Pract | meta-analysis | supports | moderate | MA: sweetened soft drinks (incl. artificially sweetened) associated with higher CVD events/mortality. |
Disagree, or know a study we missed?
We grade by evidence, not opinions. The way to weigh in is to point us to a study we haven't cited (check the evidence table above first), or to flag a problem with one we have. Every submission is reviewed; if it holds up, the grade updates and shows in Science Changes Its Mind.
Opens a short form. You'll sign in with Google so submissions are tied to a real account — we don't display your identity, and we only accept a link we can verify (PubMed, DOI, ClinicalTrials.gov).
Educational only, not medical advice. Grades and scores reflect published evidence weighted by study design and quality; see the methodology.