A large observational study has raised questions about food preservatives and heart risk, identifying eight widely consumed additives associated with higher rates of hypertension and cardiovascular disease. The research, published in the European Heart Journal, cannot establish that the preservatives caused the observed outcomes, but its authors say the findings are sufficient to warrant a formal re-evaluation by food safety regulators.
What the NutriNet-Santé study found on food preservatives and heart risk
The analysis drew on data from NutriNet-Santé, an ongoing French study examining nutrition and health. It included 112,395 volunteers, and the American College of Cardiology‘s summary of the work notes that participants had a mean age of 42 years and were 79% women, with data collected from 2009 to 2024. Participants were followed for an average of seven to eight years, during which researchers tracked whether they developed high blood pressure or cardiovascular events including heart attack, stroke, or angina.
Dietary data collection was unusually detailed. Rather than relying on broad estimates, the study used repeated 24-hour dietary records (up to 96 per participant) that included commercial brand information. Exposure to food additives was then assessed using multiple compositional databases and laboratory assays of food matrices, according to the American College of Cardiology summary. The result was a granular picture of what participants actually consumed and which preservatives they were exposed to over time.
Preservative exposure was close to universal: during the first two years of participation, 99.5% of volunteers consumed at least one food preservative.
Eight specific additives associated with hypertension
Researchers examined 17 of the most commonly consumed preservatives. Eight were specifically associated with a higher risk of high blood pressure: potassium sorbate (E202), potassium metabisulphite (E224), sodium nitrite (E250), ascorbic acid (E300), sodium ascorbate (E301), sodium erythorbate (E316), citric acid (E330) and extracts of rosemary (E392). Ascorbic acid (E300) was also specifically associated with cardiovascular disease.
The risk gradients across the full sample were measurable. Participants with the highest intake of non-antioxidant preservatives (those used primarily to prevent bacteria and mould) had a 29% higher risk of hypertension than those consuming the lowest amounts, and a 16% higher risk of cardiovascular disease. People consuming the greatest quantities of antioxidant preservatives, which slow oxidation rather than targeting microorganisms, had a 22% higher risk of hypertension.
Hasenböhler, PhD student and one of the study’s lead authors, said: ‘Food preservatives are used in hundreds of thousands of industrially processed foods. Experimental studies suggest that some preservative food additives may be harmful to cardiovascular health, but we have not had enough evidence on the impact of these ingredients in humans. As far as we know, this is the first study of its kind to investigate the links between a wide range of preservatives and cardiovascular health.’
Observational limits and the question of mechanism
The study’s design means it can identify associations, not causes. Dr Mathilde Touvier, research director at INSERM, acknowledged those limits directly: ‘This study has some limitations inherent to its observational design. However, the findings are based on highly detailed data, and we have taken account of other factors that can increase or lower the risk of cardiovascular disease.’
Two biological pathways are under investigation. One involves oxidative stress, in which reactive molecules accumulate faster than the body can neutralise them, potentially damaging cells and tissues. The other concerns pancreatic function: the pancreas regulates blood sugar and metabolism, so any preservative-driven disruption could have wider systemic effects. Dr Touvier noted that experimental research ‘consistently suggested that preservatives may cause oxidative stress in the body or affect the way the pancreas works.’
The research team is now investigating how food additives and ultra-processed foods may influence inflammation, the metabolic profile of the blood, and the gut microbiota, the community of microorganisms in the digestive tract that has attracted growing interest for its possible roles in immune function and cardiovascular health.
On the regulatory question, Dr Touvier was direct: ‘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.’ In the meantime, she said, the findings support existing recommendations to favour minimally processed foods and avoid unnecessary additives. Whether EFSA or the FDA move to act will be the test of whether the observational signal translates into regulatory consequence.
