Eur Heart J
Food preservatives tied to higher BP, cardio risk
Clinical Takeaway: Counseling patients toward fresh and minimally processed foods may matter beyond familiar targets like sodium, sugar, and saturated fat.
Preservative additives are almost ubiquitous across the industrial food supply. But cohort studies have generally lacked brand-level data on additive content, limiting human cardiovascular evidence to a few well-studied compounds such as nitrites in processed meat. This analysis tested whether cumulative exposure to a broad range of preservatives was tied to incident hypertension and cardiovascular disease.
Participants with the highest intake of non-antioxidant preservatives, the class used to suppress microbial growth, had a 29% higher risk of hypertension and a 16% higher risk of cardiovascular disease, including a 26% higher risk of coronary heart disease as compared with the lowest consumers. Antioxidant preservatives, which prevent fats and pigments from oxidizing, carried a 22% higher hypertension risk.
Exposure was nearly universal: 99.5% of participants had consumed at least one preservative within their first two years in the cohort, so the comparison is largely between higher and lower consumers rather than exposed versus unexposed.
Eight of the 17 individual additives consumed by at least 10% of participants were independently linked to hypertension after correction for multiple testing, spanning chemically distinct groups: potassium sorbate, potassium metabisulphite, sodium nitrite, ascorbic acid, sodium ascorbate, sodium erythorbate, citric acid, and rosemary extracts. The breadth across compound classes suggests the signal is not driven by a single ingredient. Ascorbic acid, the additive form of vitamin C, was also tied to higher cardiovascular disease incidence, despite naturally occurring vitamin C from fruits and vegetables generally tracking with lower cardiovascular risk in prior studies.
The prospective cohort study followed 112,395 adults from 2009 to 2024 using repeated 24-hour dietary records linked to brand-specific composition databases. Models adjusted for demographics, lifestyle, and dietary factors including ultra-processed food intake, sodium, fiber, fruits and vegetables, and red and processed meats.
Over a median of 7.9 years, researchers identified 2,450 cardiovascular and 5,544 hypertension events. The cohort skewed female, younger, and more educated than the general French population.
"These results suggest we need a re-evaluation of the risks and benefits of these food additives by the authorities in charge, such as the EFSA in Europe and the FDA in the USA, for better consumer protection," said senior author Mathilde Touvier, PhD, research director at INSERM.
Source: Hasenböhler A. Eur Heart J. 2026 May 21. Preservative food additives, hypertension, and cardiovascular diseases: the NutriNet-Santé study