Sweeteners · Metabolic & Cardiometabolic
erythritol increases cardiovascular disease
Part of: • erythritol
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: Population patterns (Observational)
How the studies fall
What the evidence shows
A single high-profile research program (Hazen lab, *Nature Medicine* 2023) reported that higher circulating erythritol predicts 3-year major adverse cardiovascular events across three cohorts, and that erythritol enhances platelet reactivity and thrombosis in mechanistic models. Provocative and mechanistically coherent — **but graded `insufficient` on purpose**: it is essentially one group, not in
The evidence (7)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Abushamat et al. 2025 · JACC Adv | observational | supports | high | ARIC cohort (n=4,006, independent of the original lab): higher circulating erythritol and its metabolite erythronate associated with incident cardiovascular events in older adults. |
| Berry et al. 2025 · J Appl Physiol | in-vitro | supports | moderate | Independent in-vitro work: erythritol impaired brain microvascular endothelial cell function (oxidative stress, reduced nitric oxide) — mechanistic support. |
| Huang et al. 2025 · Cardiol Rev | observational | mixed | moderate | Review of artificial sweeteners and CVD: erythritol among emerging concerns, evidence not yet conclusive. |
| Fan et al. 2025 · Am J Prev Cardiol | observational | mixed | moderate | Two-sample Mendelian-randomization study of erythritol and CVD/stroke/diabetes: causal genetic evidence debated across sensitivity analyses (does not cleanly confirm causation). |
| Witkowski et al. 2024 · Arterioscler Thromb Vasc Biol | observational | supports | moderate | Brief report (same group): erythritol ingestion, but not glucose, enhanced platelet reactivity and thrombosis potential in healthy volunteers. |
| Wolnerhanssen & Meyer-Gerspach 2025 · Cardiovasc Res | observational | mixed | moderate | Review ('friend or foe?'): erythritol/xylitol cardiovascular signals real but confounded by endogenous production; net uncertain. |
| Witkowski et al. 2023 · Nat Med | observational | supports | high | Nature Med: circulating erythritol associated with 3-yr MACE across 3 cohorts (adjusted HR ~1.8-2.2, top vs bottom quartile); erythritol enhanced platelet reactivity in vitro and thrombosis in vivo; ingestion in 8 volunteers raised plasma levels above prothrombotic thresholds for >2 days. |
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Educational only, not medical advice. Grades and scores reflect published evidence weighted by study design and quality; see the methodology.