looking at the On the ingredient labels of foods found on supermarket shelves, it is common to see names such as “potassium sorbate,” “citric acid,” and “L-ascorbic acid (vitamin C).” These substances are food additives used to prevent spoilage and preserve quality, and are widely incorporated into industrially produced processed foods. According to Open Food Facts, the world’s largest open food database, more than 20 percent of the processed foods and beverages in its database contain at least one preservative.

In this context, a research team led by scientists from the Sorbonne University Paris Nord and the Université Paris Cité analyzed data from the large-scale NutriNet-Santé cohort study, which followed 112,395 participants for an average of 7.9 years, to investigate the relationship between the intake of dietary preservatives and the risk of developing hypertension and cardiovascular diseases.

“Experimental studies suggest that some preservative food additives may be harmful to cardiovascular health, but we have not had sufficient evidence on the impact of these ingredients in humans,” Anaïs Hasenböhler, a doctoral researcher who led the study, said in a news release. “To our knowledge, this is the first study of its kind to investigate links between a wide range of preservatives and cardiovascular health.”

8 preservatives linked to the risk of hypertension

Researchers divided preservatives into two broad categories. The first consisted of non-antioxidant preservatives, such as sorbates, nitrites and sulfites, which inhibit the growth of mold and bacteria. The second consisted of antioxidant preservatives, including ascorbic acid, citric acid and erythorbates, which prevent oxidation and discoloration of foods. According to the researchers, almost all participants (99.5 percent) consumed at least one preservative during the first two years of the study.

The analysis found that participants with the highest intake of non-antioxidant preservatives had a 29 percent higher risk of developing hypertension than those with the lowest intake. They also had a 16 percent higher risk of cardiovascular disease overall, including heart attacks, strokes and angina. Participants with the highest intake of antioxidant preservatives also showed a 22 percent increased risk of hypertension.

The researchers also examined the 17 most consumed preservatives individually. Of these, eight were associated with an increased risk of 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). Among them, ascorbic acid was also associated with an increased risk of cardiovascular disease.

During the follow-up period, the researchers recorded 5,544 cases of hypertension and 2,450 cases of cardiovascular disease, including 1,142 cerebrovascular events and 1,308 cases of coronary artery disease. The study also found that approximately 16 percent of the association between non-antioxidant preservatives and cardiovascular disease was indirectly mediated by hypertension. In other words, the findings suggest that preservatives may contribute to hypertension, which in turn may increase the risk of cardiovascular disease.

Calls to reevaluate regulations on food additives

The researchers emphasize that these findings come from an observational study and do not establish a causal relationship between food preservatives and hypertension or cardiovascular disease. The study also has important limitations. Women accounted for 78.7 percent of participants, and the cohort included a relatively high proportion of highly educated people, meaning it is not perfectly representative of the general population.

Still, the statistical models took into account a wide range of potential confounders and the results remained consistent across multiple sensitivity analyses.

“These results suggest that we need a reassessment of the risks and benefits of these food additives by responsible authorities, such as the EFSA in Europe and the FDA in the US, for better consumer protection,” Mathilde Touvier, research director at the French National Institute for Health and Medical Research, said in a news release. “Meanwhile, these findings support existing recommendations to favor unprocessed and minimally processed foods, and avoid unnecessary additives.”

The possibility that preservatives long considered safe could affect cardiovascular health raises important questions about current regulatory approaches. For additives that are continually consumed in multiple foods without numerical limits on their use, the findings suggest it may be time to reopen the debate about whether existing regulations are adequate.

This story originally appeared on Japan wired and has been translated from Japanese.