Table 2.

Associations between intake of total artificial sweeteners, aspartame, acesulfame potassium, and sucralose and overall cardiovascular diseases, coronary heart diseases and cerebrovascular diseases, NutriNet-Santé cohort, France, 2009-21 (n=103 388)

Outcome and exposure	Hazard ratio (95% CI)	P value
Cardiovascular diseases (n=1502)
Total artificial sweeteners	1.09 (1.01 to 1.18)	0.03
Aspartame	1.03 (0.94 to 1.14)	0.49
Acesulfame potassium	1.18 (0.98 to 1.41)	0.08
Sucralose	1.11 (0.92 to 1.34)	0.28
Coronary heart diseases (n=730)
Total artificial sweeteners	1.02 (0.91 to 1.14)	0.79
Aspartame	0.91 (0.78 to 1.06)	0.22
Acesulfame potassium	1.40 (1.06 to 1.84)	0.02
Sucralose	1.31 (1.00 to 1.71)	0.05
Cerebrovascular diseases (n=777)
Total artificial sweeteners	1.18 (1.06 to 1.31)	0.002
Aspartame	1.17 (1.03 to 1.33)	0.02
Acesulfame potassium	1.01 (0.79 to 1.29)	0.93
Sucralose	0.99 (0.76 to 1.29)	0.93

Median follow-up times for overall cardiovascular, coronary heart, and cerebrovascular diseases were all 9.0 years; person years were 904 205, 904 270, and 904 259, respectively. Exposure was coded as log10 of artificial sweetener intake in mg/day+1. Main models were adjusted for age (time scale), sex, physical activity (categorical: International Physical Activity Questionnaire variable: high, moderate, low, missing value), smoking status (categorical: never, former, current smoker), number of smoked cigarettes in pack years (continuous), higher educational level (categorical: less than high school degree, <2 years after high school degree, ≥2 years after high school degree), family history of cardiovascular disease (categorical: yes, no), energy intake without alcohol (continuous: kcal/day), daily intakes (continuous: g/day) of alcohol, sodium, saturated fatty acids, polyunsaturated fatty acids, fibre, sugar, fruit and vegetables, red and processed meat. Models were also mutually adjusted for sweetener intake other than the one studied (continuous).