Looking at the ingredient labels on supermarket shelves, you’ll often see names such as “potassium sorbate,” “citric acid,” and “L-ascorbic acid (vitamin C).” These additives are used to prevent spoilage and preserve quality, and they appear in many industrially produced processed foods. Open Food Facts, the world’s largest open food database, reports that more than 20 % of the processed foods and beverages it tracks contain at least one preservative.
Researchers from Sorbonne Paris Nord University and Université Paris Cité examined data from the NutriNet‑Santé cohort, which followed 112,395 participants for a median of 7.9 years, to assess whether dietary preservative intake is associated with hypertension and cardiovascular disease.
“Experimental studies suggest that some preservative additives may be harmful to cardiovascular health, but human evidence has been limited,” said Anaïs Hasenböhler, the doctoral researcher who led the study. “To our knowledge, this is the first study to evaluate a broad range of preservatives in relation to cardiovascular outcomes.”
Eight Preservatives Associated with Hypertension
The team classified preservatives into two groups. Non‑antioxidant preservatives—such as sorbates, nitrites, and sulfites— inhibit mold and bacterial growth. Antioxidant preservatives—including ascorbic acid, citric acid, and erythorbates—prevent oxidation and discoloration. Nearly every participant (99.5 %) consumed at least one preservative during the first two years of the study.
Participants with the highest intake of non‑antioxidant preservatives had a 29 % higher risk of developing hypertension and a 16 % higher risk of overall cardiovascular disease (including heart attack, stroke, and angina) compared with those with the lowest intake. High intake of antioxidant preservatives was linked to a 22 % increased risk of hypertension.
When the 17 most commonly consumed preservatives were examined individually, eight showed a significant association with hypertension: potassium sorbate (E202), potassium metabisulfite (E224), sodium nitrite (E250), ascorbic acid (E300), sodium ascorbate (E301), sodium erythorbate (E316), citric acid (E330), and rosemary extract (E392). Ascorbic acid was also linked to a higher risk of cardiovascular disease.
During follow‑up, researchers recorded 5,544 cases of hypertension and 2,450 cases of cardiovascular disease, including 1,142 cerebrovascular events and 1,308 coronary artery disease cases. Approximately 16 % of the link between non‑antioxidant preservatives and cardiovascular disease was mediated indirectly through hypertension, suggesting that preservatives may contribute to high blood pressure, which in turn raises cardiovascular risk.
Calls for Reassessment of Food‑Additive Regulations
The authors stress that the study is observational and does not prove causation. Limitations include a sample that was 78.7 % female and relatively highly educated, which may not fully represent the general population.
Nevertheless, the statistical models accounted for a wide range of potential confounders, and the findings remained consistent across multiple sensitivity analyses.
“These results suggest a need to reevaluate the risks and benefits of these food additives by authorities such as the EFSA in Europe and the FDA in the United States, to better protect consumers,” said Mathilde Touvier, research director at the French National Institute of Health and Medical Research. “In the meantime, the findings reinforce existing recommendations to favor non‑processed and minimally processed foods and to avoid unnecessary additives.”
The possibility that preservatives long considered safe could affect cardiovascular health raises important questions about current regulatory approaches. For additives consumed continuously across multiple foods without numerical limits, the findings suggest it may be time to reopen the debate over whether existing regulations are adequate.
