A growing body of research shows that ultra-processed foods, and notably artificial sweeteners, increase the risk of cardiovascular disease and cardiovascular disease mortality.
Cardiovascular disease (CVD) is an umbrella term for diseases that affect the heart and blood vessels. These conditions include coronary artery disease, cerebrovascular disease, peripheral arterial disease, carditis, heart failure, and arrhythmias. Cardiovascular diseases are the leading cause of death in the United States and worldwide.
Scientists say the consumption of ultra-processed foods (UPFs) may promote cardiovascular disease through several mechanisms. Because UPFs are typically high in refined sugars, salt, carbohydrates, unhealthy fats, and/or artificial additives, they can contribute to obesity, high blood pressure, and Type 2 diabetes, all of which are risk factors for cardiovascular disease. A diet high in these foods may displace more nutritious options, leading to a poor diet, further increasing the risk of cardiovascular disease.
UPFs have become a staple in the American diet. Today, about 57% of the calories American adults consume comes from UPFs. That percentage rises to 67% in American children.
What is the scientific evidence linking ultra-processed foods and cardiovascular disease-related mortality?
In a 2024 large umbrella review that included 45 epidemiological meta-analyses that included the data of nearly 10 million people to evaluate the associations between ultra-processed food consumption and a variety of adverse health outcomes. The research, which was published in BMJ, showed that “the strongest available evidence pertained to direct associations between greater exposure to ultra-processed foods and higher risks of all cause mortality, cardiovascular disease related mortality,” along with several other adverse health conditions. Notably, the study authors wrote: “One meta-analysis study specifically pooled heart disease related deaths, such as ischaemic heart disease related mortality and cerebrovascular disease related mortality, with each 10% increase in total ultra-processed food exposure.”
In the American Journal of Clinical Nutrition, a longitudinal analysis published in 2021 investigated ultra-processed food consumption and mortality risk in an Italian adult population through self-reported questionnaires on diet and health. The research included more than 22,000 men and women. The results showed: “Individuals reporting the highest intake of UPF experienced increased risks of CVD mortality, death from ischemic heart disease, and all-cause mortality. High sugar content explained 36.3% of the relation of UPF with IHD/cerebrovascular mortality.”
In a large prospective multicenter study published in 2021 in the International Journal of Behavioral Nutrition and Physical Activity, researchers examined the data of more than 90,000 people to investigate associations between ultra-processed food consumption and cardiovascular disease mortality. After adjusting for lifestyle and other risk factors, the scientists found that participants in the highest versus lowest quintiles of ultra-processed food consumption had higher risks of death from cardiovascular disease and heart disease. Notably, the study authors observed that “the increased risks of mortality from ultra-processed foods were significantly higher in women than in men.”
An observational study published in the American Journal of Clinical Nutrition in 2023 examined the risk of cardiovascular disease in people with Type 2 diabetes. Researchers found: “In participants with Type 2 diabetes at study entry, higher UPF consumption was associated with reduced survival and higher CVD mortality rate, independent of diet quality.” Researchers concluded: “Besides prioritizing the adoption of a diet based on nutritional requirements, dietary guidelines for the management of Type 2 diabetes should also recommend limiting UPF.”
What is the scientific evidence linking ultra-processed foods and overall cardiovascular disease?
In a meta-analysis published in eClinical Medicine in 2024, researchers assessed 20 observational studies that included the data of more than 1 million people to examine the relationship between eating ultra-processed foods and the risk of cardiovascular events (CVEs). They found a “10% increase of UPF by daily weight proportion was associated with a 1.9% increase of CVEs risk, an additional daily serving corresponding to 2.2% CVEs risk increase, and 10% increase by daily energy proportion corresponding to 1.6% CVEs risk increase.” The researchers concluded: “UPF consumption [was] associated with a higher risk of CVEs in the positive linear relationship. Our findings highlight the importance of minimizing UPF consumption for cardiovascular health and might help to pursue public health policies in control of UPF consumption.”
A large observational prospective study using the NutriNet-Santé cohort in France examined the associations between ultra-processed foods and cardiovascular disease risk. The study included the data of more than 100,000 adult participants and had a median follow-up of 5.2 years. The research, which was published in BMJ in 2019, found that “intake of ultra-processed food was associated with a higher risk of overall cardiovascular disease, coronary heart disease risk, and cerebrovascular disease risk. These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (saturated fatty acids, sodium and sugar intakes, dietary fibre, or a healthy dietary pattern derived by principal component analysis) and after a large range of sensitivity analyses.”
In a prospective cohort study published in the Journal of the American College of Cardiology in 2021, researchers analyzed the data of more than 3,000 adults who were free of cardiovascular disease at baseline. They examined the incidences of overall CVD, CVD mortality, hard CVD, which referred to “sudden and nonsudden coronary death, myocardial infarction, and fatal/nonfatal stroke,” and hard CHD, “or sudden/nonsudden coronary death and myocardial infarction.” The participants were middle-aged and overweight at baseline. In a mean follow-up of 18 years, researchers found: “Compared with participants consuming the least ultra-processed foods, those with the highest intakes had higher incidence rates per 1000 person-years of hard CVD and hard CHD. … A 1 standard deviation increase in ultra-processed food intake was associated with 22% and 30% increased risk of hard CVD and hard CHD, respectively. Each additional serving of ultra-processed food was associated with a 7% increase in the risk of hard CVD and a 9% increase in the risk of hard CHD in multivariable-adjusted models.
“A higher proportion of UPF consumption was associated with CVD and all-cause mortality,” researchers concluded in a study published in the European Journal of Public Health in 2022. The scientists had sought to examine the association between ultra-processed food consumption and cardiovascular disease and all-cause mortality. Using data from the UK Biobank Cohort, the observational prospective study assessed the data of more than 60,000 people 40 years of age and older. The results showed: “A higher intake of UPF was associated with a higher risk of CVD , coronary heart disease, cerebrovascular disease and all-cause mortality. The association of UPF consumption with a range of CVD incidents and all-cause mortality was monotonic.”
In a 2023 prospective cohort published in BMC Medicine, researchers examined the links between ultra-processed food, circulating protein biomarkers, and cardiovascular disease risk. The research included data from more than 26,000 participants in Sweden. Results showed, during 24.6 years of median follow-up, 6236 participants developed CVD, of whom 3566 developed coronary heart disease and 3272 developed ischemic stroke. The adjusted hazard ratio in the 4th versus 1st quartile of UPF was 1.18 for CVD, 1.20 for coronary heart disease, and for ischemic stroke. Several protein biomarkers, including plasma proteins interleukin 18, tumor necrosis factor receptor 2, and macrophage colony-stimulating factor 1 were positively associated with UPF consumption. The study concluded: “High UPF intake increased the risk of CVD and was associated with several protein biomarkers. Future studies are warranted to validate these findings and assess the potential pathways between UPF intake and CVD.”
A prospective study published in 2021 in the European Heart Journal, researchers examined the link between UPFs and cardiovascular disease events from a sample in Greece. More than 3,000 adults who were free of CVD at baseline were included in the study. In follow-up assessments 10 to 11 years later, results showed: “Ranking from 1st to 3rd ultra-processed food consumption tertile (low to high level of intake) CVD incidence was 8.1%, 12.2%, 16.6%. Each additional weekly serving of ultra-processed food was associated with 10% higher CVD risk within the decade.” The researchers concluded: “Current findings support that even in a population with Mediterranean origins and easy access to healthy least processed choices, systematic consumption of ultra-processed foods on a weekly basis was associated with increased risk of hard CVD events.”
In a dose-response meta-analysis published in 2023 in the Food & Function, researchers examined eleven papers that investigated the association between ultra-processed food consumption and cardiovascular events (CVEs). They found: “The pooled effect size for the highest versus lowest category of UPF consumption showed positive associations with the risk of CVEs. … For each additional daily serving of UPF, the risk increased by 4% for CVEs and 2% for all-cause mortality. With increasing UPF intake, the risk of CVEs reflected a linear upward trend.”
A review published in Nutrients in 2020 assessed several health outcomes related to ultra-processed foods. Of the 43 studies assessed, 37 found an association between UPF consumption and at least one adverse health outcome. Among those health outcomes, researchers found links between UPFs and cardio-metabolic risks, along with cardiovascular disease. In children, links were shown between UPF consumption and cardio-metabolic risk. Notably, the researchers wrote: “No study reported an association between UPF and beneficial outcomes.”
What is the scientific evidence linking ultra-processed foods with coronary artery disease and atherosclerosis?
In a 2021 study published in the Journal of Nutrition, examined whether ultra-processed foods were associated with an increased risk of coronary artery disease in a study sample of more than 13,000 adults between the ages of 45 and 65. The researchers used data from self-reported questionnaires to determine diet. Results showed that, over a median follow-up of 27 years, “incidence rates were higher in the highest quartile of ultra-processed food intake compared with the lowest quartile. Participants in the highest compared with lowest quartile of ultra-processed food intake had a 19% higher risk of coronary artery disease after adjusting for sociodemographic factors and health behaviors. The researchers concluded: “Higher ultra-processed food intake was associated with a higher risk of coronary artery disease among middle-aged US adults.”
In a case-control study based in Iran that included more than 2,300 adults, researchers sought to assess how ultra-processed food consumption affected risk of premature coronary artery disease (PCAD). The research, published in Frontiers in Nutrition in 2023, found: “After adjustment for potential confounders, participants in the top tertile of UPFs were twice as likely to have PCAD compared with those in the bottom tertile. Moreover, those in the highest tertile of the UPFs consumption had more than two times higher risk for having severe PCAD than those in the first tertile. In addition, there was a significant upward trend in PCAD risk and PCAD severity as tertiles increased.”
In a 2020 study published in BMC Medicine in 2020, researchers investigated an association between ultra-processed food consumption and coronary atherosclerosis risk using computed tomography scans and self-reported diet questionnaires from more than 1,000 men. They found that “approximately 500 g/day of UPF consumption was associated with a 2-fold greater prevalence of subclinical coronary atherosclerosis than consuming only 100 g/day, independently of total energy intake and other well-established cardiovascular risk factors.”
What is the scientific evidence linking ultra-processed foods and increased risk of arrhythmia?
In a 2023 study published in Heart, researchers examined the association between UPF consumption and risk of atrial fibrillation. Researchers used data from the UK Biobank that included more than 120,000. They found that the “greatest ultra-processed food consumption was associated with a significant increase in atrial fibrillation risk even in fully adjusted models, and a 10% increase in absolute intake of ultra-processed food was associated with a 5% increase in atrial fibrillation risk.”
What is the scientific evidence that artificial sweeteners increase cardiovascular disease risk?
Artificial sweeteners like aspartame and sucralose are common ingredients used as sugar substitutes in ultra-processed foods and beverages. Research shows that these sweeteners are associated with an increased risk of cardiovascular disease.
Artificial sweeteners may affect the body’s metabolism, gut microbiota, and insulin response, all of which could impact cardiovascular health.
In a 2022 review published in BMJ, researchers sought to examine the association between artificial sweeteners and the risk of cardiovascular diseases (including overall disease, coronary heart disease, and cerebrovascular disease). The research included the data of more than 100,000 participants in the French population-based NutriNet-Santé cohort. The researchers found: “Artificial sweeteners were more particularly associated with cerebrovascular disease risk. Aspartame intake was associated with increased risk of cerebrovascular events, and acesulfame potassium and sucralose were associated with increased coronary heart disease risk.”
A review published in Nature Medicine in 2023 examined the association between the sweetener erythritol and cardiovascular event risks. The researchers found that “erythritol is both associated with incident MACE [major adverse cardiovascular events] risk and fosters enhanced thrombosis.”
Diet beverages are typically sugar-free and artificially sweetened. They are often seen as a low-calorie alternative to drinks that contain sugar. A 2014 study from the Women’s Health Initiative published in the Journal of General Internal Medicine found that post-menopausal women who consumed more than two diet drinks per day “had a 30% higher adjusted risk of [cardiovascular disease] events as well as overall mortality compared to those with an intake of 0-3 diet drinks per month.” This was found even after adjusting for other cardiovascular disease risk factors. The research included data from nearly 60,000 women.
A review published in May 2023 in Advances in Nutrition included data of 11 meta-analyses obtained from 7 systematic reviews (51 cohort studies and 4 case-control studies). The review reported that artificially sweetened beverages were associated with higher risk of several adverse health effects, including cardiovascular disease incidence. In their conclusion, researchers wrote: “Changes in the gut microbiota or an increased production of inflammatory markers have been suggested as possible mechanisms linking artificially sweetened beverages and health outcomes.”
Journalism and Opinion
Ultra-processed food raises risk of heart disease and stroke, two studies show, by Andrew Gregory, Guardian, Aug. 27, 2023
Eating processed foods can increase your risk of early death from heart disease by 58%, study finds, by Gabby Landsverk, Business Insider, Jan. 4, 2021
Ultraprocessed foods linked to heart disease, diabetes, mental disorders and early death, study finds, by Sandee LaMotte, CNN, Feb. 28, 2024
Ultra-processed food is associated with cardiovascular disease, by Anna Clark, British Heart Foundation, Aug. 27, 2021
Ultra-processed foods linked to 32 health problems: What to know, by Rachel Pannett, Washington Post, Feb. 29, 2024
Read our other fact sheets on the studies that link ultra-processed foods to other severe health risks, including dementia, depression, Type 2 diabetes, addiction, cancer, obesity, and premature death. Also, see our fact sheets on the health risks of the artificial sweeteners sucralose and aspartame.
