Summary:
Preservatives are commonly used in processed foods to extend shelf life. Although these additives are considered safe within regulated limits, concerns remain about their long-term health effects. Studies have examined isolated food additives, but limited evidence exists that examines overall exposure to multiple preservatives in relation to particular health conditions such as cardiovascular outcomes. This prospective cohort study investigated whether dietary exposure to preservative food additives was associated with the development of cardiovascular disease (CVD) and hypertension. The study used data from the French NutriNet-Santé cohort, which followed more than 112,000 participants from 2009 to 2024. Participants provided detailed dietary records, allowing researchers to estimate exposure to 58 different preservative additives. Health outcomes, including coronary heart disease, stroke and hypertension, were identified through participant reports and records. Nearly all participants consumed foods containing preservative additives, with the highest exposures associated with greater intake of ultra-processed foods. The study found that higher consumption of non-antioxidant preservatives was associated with an increased risk of CVD and coronary heart disease. Higher intake of total preservatives was also associated with a greater risk of developing hypertension. Several individual additives, including sorbates, sulphites, nitrites and ascorbates were linked with increased hypertension risk. The findings suggest that long-term exposure to commonly consumed preservative food additives may contribute to cardiovascular risk. The authors highlight that these results support recommendations to favour fresh and minimally processed foods where possible.
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Abstract:
Background and Aims: Experimental studies suggest that some preservative food additives may exert adverse cardiovascular effects, yet human data are lacking. The associations between exposure to these compounds and incidence of hypertension and cardiovascular diseases (CVD) were investigated in the NutriNet-Santé cohort (France, 2009–2024). Methods: Dietary intakes were assessed using repeated 24-h dietary records (up to 96), including commercial brands. Exposure to food additives was evaluated through multiple composition databases and ad hoc laboratory assays in food matrices. Associations between cumulative time-dependent exposures to preservative food additives during follow-up and outcomes were characterized using multi-adjusted Cox models. Results: Overall, 112 395 participants were included (78.7% women, mean age 42.8 ± 14.7 years) with a median follow-up of 7.9 years. The sum of total preservatives encompassed 58 substances consumed by at least one participant. Total non-antioxidant preservatives were positively associated with higher incidences of hypertension [n = 5544; hazard ratio (HR) higher vs. lower consumers: 1.29, 95% confidence interval (CI) 1.20–1.39] and CVD (n = 2450; HR 1.16, 95% CI 1.04–1.29), while total antioxidant preservatives were associated with higher incidence of hypertension (HR 1.22, 95% CI 1.13–1.31). Out of the 17 individual preservative food additives consumed by at least 10% of the study population, eight were associated with higher incidence of hypertension and one with higher incidence of CVD, after multiple test correction. Conclusions: Multiple associations between exposure to preservative food additives widely used in industrial foods and higher incidence of hypertension or CVD were observed in this large prospective cohort. Experimental research is needed to gain insight into underlying mechanisms. If confirmed, these new data call for the re-evaluation of regulations governing the use of these additives to improve consumer protection.
Article Publication Date: 20/05/2026
DOI: 10.1093/eurheartj/ehag308
