An artificial sweetener known as sugar alcohol has never sounded like the healthiest thing for people, according to MedicalNewsToday. Turns out, it may not be.

In a study published in the European Heart Journal, Cleveland Clinic researchers report that higher amounts of xylitol, a type of sugar alcohol, can increase risk of heart attack, stroke, and other cardiovascular events.

The researchers said they found the associations in a large-scale patient analysis, a clinical intervention study, and preclinical research models.

Xylitol is a lower-calorie sugar substitute with a low glycemic index. Sugar alcohols are carbohydrates that don’t actually contain alcohol.

Xylitol occurs naturally in small amounts in fibrous fruits and vegetables, corn cobs, trees, and the human body. It’s used as a sugar substitute because its taste is comparable to sugar but has fewer calories.

Xylitol is found in many products, ranging from sugar-free candy and gum to toothpaste. People also use it as a sweetener and for baking.

The research team said over the past decade, sugar substitutes such as sugar alcohols and artificial sweeteners have significantly increased in processed foods promoted as healthy alternatives.

The Cleveland Clinic team found a similar link between another sugar alcohol, erythritol, and cardiovascular risk last year. They said in a statement that xylitol isn’t as common as erythritol in keto or sugar-free products in the United States, but they noted it is common in other countries.

“This study again shows the immediate need for investigating sugar alcohols and artificial sweeteners, especially as they continue to be recommended in combating conditions like obesity or diabetes,” said Dr. Stanley Hazen, the chairperson of Cardiovascular and Metabolic Sciences at Cleveland Clinic’s Lerner Research Institute as well as the co-section head of preventive cardiology in the Heart, Vascular and Thoracic Institute, in the statement.

“It does not mean throw out your toothpaste if it has xylitol in it, but we should be aware that consumption of a product containing high levels could increase the risk of blood clot related events,” Hazen added.

In an analysis of more than 3,000 subjects in the United States and Europe, the researchers reported that high levels of circulating xylitol were associated with an elevated three-year risk of cardiovascular events.

A third of subjects with the highest amount of xylitol in their plasma were found more likely to experience a cardiovascular event.

The team conducted pre-clinical testing to confirm the findings. They discovered xylitol caused clotting in platelets and heightened risk of thrombosis.

The researchers also tracked platelet activity from subjects who ingested a xylitol-sweetened drink versus a glucose-sweetened drink. They found every measure of clotting ability significantly increased immediately following ingestion of xylitol but not glucose.

The team said the study had several limitations, including that clinical observation studies demonstrate association and not causation. They said more studies are needed to assess the long-term cardiovascular safety of xylitol.