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 et al. 2025 · Nutr Rev | meta-analysis | supports | moderate | Umbrella review of meta-analyses: evidence on non-sugar-sweetened beverages and chronic-disease/mortality risk inconclusive. |
| Debras et al. 2022 · BMJ | observational | supports | moderate | NutriNet-Santé: artificial sweeteners (esp. aspartame, sucralose) associated with higher cardiovascular disease risk (coronary + cerebrovascular). |
| Meng 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 et al. 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 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 et al. 2025 · Appl Physiol Nutr Metab | meta-analysis | contradicts | high | Bias-adjusted cohort analyses: NNS associated with LOWER coronary heart disease and cardiovascular/all-cause mortality. |
| Owu RT et al 2025 · study_type: animal | 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 et al. 2024 · Curr Dev Nutr | meta-analysis | tested-null | low | 6-beverage long-term MA: associations for ASB and cardiovascular mortality inconsistent across sexes/studies. |
| Queiroz et al. 2025 · Curr Probl Cardiol | meta-analysis | supports | moderate | MA: high ASB consumption associated with increased long-term cardiovascular events. |
| Narain et al. 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.
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Educational only, not medical advice. Grades and scores reflect published evidence weighted by study design and quality; see the methodology.