Take a look at the ingredient list on a loaf of bread, bottle of dressing, package of deli meat, or flavored drink, and you may spot names such as potassium sorbate, citric acid, or sodium erythorbate.
These ingredients help food last longer, resist mold, maintain its color, or avoid developing unpleasant flavors. But a large study has raised new questions about whether regularly consuming higher amounts of certain preservative additives could be connected to heart health.
The research, published in the European Heart Journal, followed more than 112,000 adults in France. Higher intake of eight commonly consumed preservatives was associated with a greater incidence of high blood pressure. One—ascorbic acid when used as a food additive—was also associated with cardiovascular disease.
That sounds alarming, but the wording matters. The study found an association; it did not prove that any additive caused high blood pressure, a heart attack, or a stroke. It also does not mean vitamin C-rich fruit, citrus, or fresh rosemary is bad for your heart.
Key Takeaways
The study included 112,395 adults and followed them for a median of nearly eight years.
Higher intake of non-antioxidant preservatives was associated with a 29% higher relative incidence of hypertension and a 16% higher relative incidence of cardiovascular disease.
Higher intake of antioxidant preservatives was associated with a 22% higher relative incidence of hypertension.
Eight individual additives were associated with hypertension after the researchers corrected for multiple statistical tests.
Only additive ascorbic acid was individually associated with cardiovascular disease.
The findings are important, but this observational study cannot establish cause and effect.
Why Are Preservatives Added to Food?
Preservatives are added to foods for several reasons, including preventing the growth of bacteria and mold, slowing spoilage, and helping products maintain their color, flavor, or freshness for longer.
Some preservatives stop potentially harmful microorganisms from growing. Antioxidant preservatives work differently: they slow oxidation, a chemical process that can cause food to brown, develop off flavors, or become rancid.
Preservatives can therefore support food safety as well as shelf life. In the United States, the FDA uses several regulatory pathways for food ingredients, including approved food additives, ingredients generally recognized as safe, and prior-sanctioned substances. The agency explains those distinctions in its consumer guide to food additives and GRAS ingredients.
Because these ingredients are so widely used, the researchers wanted to understand whether long-term exposure could be connected to cardiovascular health—not whether every use of food preservation is harmful.
Tracking Diet and Heart Health in More Than 112,000 People
The study was led by Dr. Mathilde Touvier, a research director at INSERM, and doctoral researcher Anaïs Hasenböhler. Both are part of the Nutritional Epidemiology Research Team at Université Sorbonne Paris Nord and Université Paris Cité.
The work was conducted as part of NutriNet-Santé, a large ongoing project examining connections between nutrition and health. The analysis included 112,395 volunteers living across France; 78.7% were women, and the average age at enrollment was approximately 43.
Every six months, participants recorded everything they ate and drank during three 24-hour periods. Brand names were included, giving researchers unusually detailed information instead of relying only on broad estimates of food consumption.
The research team matched those records with food-composition databases and laboratory analyses to estimate the preservatives participants consumed. Health outcomes were then tracked for a median of 7.9 years for cardiovascular disease and 7.6 years for hypertension.
Preservative exposure was nearly universal. During the first two years of participation, 99.5% of volunteers consumed at least one food preservative.
During follow-up, researchers documented 5,544 new cases of hypertension and 2,450 cardiovascular events, including coronary heart disease and cerebrovascular events such as stroke.
The models accounted for factors including age, sex, body mass index, physical activity, smoking, education, alcohol, sodium, sugar, saturated fat, fiber, fruit and vegetable intake, processed meat, and the proportion of ultra-processed food in the diet.
Accounting for those factors makes the findings more persuasive, but it cannot remove every possible difference between people who consumed more or fewer additives.
Higher Preservative Intake Was Linked to Higher Risk
The strongest broad associations appeared among people consuming the largest amounts of certain preservatives.
Compared with lower consumers, higher consumers of non-antioxidant preservatives had a 29% higher relative incidence of hypertension. They also had a 16% higher relative incidence of cardiovascular disease, which included conditions such as heart attack, stroke, and angina.
People with the highest intake of antioxidant preservatives had a 22% higher relative incidence of hypertension.
These percentages are relative comparisons between intake groups. They do not mean that an individual's personal probability of developing hypertension automatically rises by the same percentage after eating a food containing one of these ingredients.
“Linked with” does not mean “proved to cause.” Do not stop eating nutritious foods, discontinue prescribed medication, or take supplements based on this study alone. High blood pressure often has no symptoms; measuring it is the only way to know whether it is high, according to the CDC.
Eight Common Preservatives Stood Out
Researchers detected 58 preservative additives in participants' diets. They individually analyzed the 17 consumed by at least 10% of the study population. Eight remained associated with a higher incidence of hypertension after correction for multiple statistical tests.
1. Potassium Sorbate (E202)
Potassium sorbate slows the growth of mold and yeast. Depending on the manufacturer, it may appear in products such as baked goods, cheese products, dips, dressings, fruit products, and beverages.
This additive showed the largest individual association in the study. Higher consumers had a 39% higher relative incidence of hypertension than lower consumers.
That result does not establish that potassium sorbate caused the difference. It describes the relative rate observed between the study's intake groups after statistical adjustment.
2. Potassium Metabisulfite (E224)
Potassium metabisulfite belongs to the sulfite family. It helps prevent browning, oxidation, and microbial spoilage and may be used in wine, cider, dried fruit, and some processed potato products.
In this cohort, alcoholic drinks accounted for 83.7% of additive sulfite intake. Higher potassium metabisulfite intake was associated with a 16% higher relative incidence of hypertension.
This possible long-term association is separate from sulfite sensitivity, which can cause acute reactions in susceptible people.
3. Sodium Nitrite (E250)
Sodium nitrite is used to cure meat, inhibit dangerous bacterial growth, and maintain the characteristic color and flavor of products such as bacon, ham, sausages, hot dogs, and some deli meats.
Processed meat supplied 54% of the nitrite additive exposure in the study. Higher sodium nitrite intake was associated with a 16% higher relative incidence of hypertension.
This analysis focused on sodium nitrite used as a food additive. It should not be confused with the naturally occurring nitrate found in vegetables, which reaches the body in a different food matrix.
4. Ascorbic Acid (E300)
Ascorbic acid is vitamin C. Manufacturers may add it to preserve color and flavor, slow oxidation, or improve dough. The same compound also occurs naturally in foods such as oranges, peppers, strawberries, and broccoli.
The distinction is crucial: the study estimated ascorbic acid used as an additive. It did not show that vitamin C-rich whole foods harm the heart.
Higher additive ascorbic acid intake was associated with a 14% higher relative incidence of hypertension. It was also the only individual preservative associated with cardiovascular disease, with a 15% higher relative incidence among higher consumers.
For substances that also occur naturally in food, the researchers separated estimated additive exposure from natural dietary exposure. Additives accounted for about 29% of total ascorbate exposure and 16% of total citric acid exposure in the cohort.
5. Sodium Ascorbate (E301)
Sodium ascorbate is another form of vitamin C used as an antioxidant preservative. It may appear in cured meats and other packaged foods where it helps protect color and quality.
Higher consumers had a 12% higher relative incidence of hypertension. As with ascorbic acid, this finding concerns its measured use as an additive and should not be interpreted as evidence against naturally vitamin C-rich foods.
6. Sodium Erythorbate (E316)
Sodium erythorbate is an antioxidant chemically related to vitamin C. It is commonly used in cured and processed meats to maintain color and slow oxidation.
Processed meat accounted for 42.1% of erythorbate additive exposure in the cohort. Higher sodium erythorbate intake was associated with a 14% higher relative incidence of hypertension.
7. Citric Acid (E330)
Citric acid occurs naturally in citrus fruit, but manufacturers also use it as an acidifier, flavoring aid, and preservative in drinks, candy, sauces, canned foods, and fruit products.
The source matters. The researchers estimated that additives accounted for about 16% of participants' total citric acid exposure. The finding is not a warning to stop eating lemons, oranges, or other whole fruit.
Higher additive citric acid intake was associated with a 25% higher relative incidence of hypertension.
8. Extracts of Rosemary (E392)
Rosemary extract can be concentrated and standardized for use as an antioxidant preservative, particularly in foods containing fats and oils. Depending on the recipe, it may appear in meat products, snacks, dressings, oils, and seasonings.
This is not the same exposure as using fresh or dried rosemary in home cooking. Higher intake of rosemary extract as an additive was associated with a 10% higher relative incidence of hypertension.
One Important Detail Most Headlines Will Miss
Nearly everyone in the study consumed at least one preservative, yet most participants did not exceed the acceptable daily intake limits used by European regulators.
No participant exceeded the established limits evaluated for sorbates, erythorbates, or nitrates. Only 96 participants exceeded the limit for sulfites, and 54 exceeded the limit for nitrites.
That does not prove current regulatory limits are unsafe. It helps explain why the researchers believe chronic cardiovascular outcomes deserve further study alongside the toxicology evidence traditionally used to evaluate additives.
Why Preservatives Might Affect the Body
One possible explanation involves oxidative stress. This occurs when reactive molecules build up faster than the body's protective systems can neutralize them, potentially damaging cells and tissues over time.
Researchers are also investigating whether some preservatives could influence pancreatic function, insulin signaling, inflammation, blood metabolism, or the gut microbiota. The pancreas plays a central role in regulating blood sugar and metabolism, while the gut microbiota includes the enormous community of microorganisms living in the digestive tract.
These remain hypotheses—not established explanations for the associations in this study. Laboratory and animal research can help identify plausible mechanisms, but it cannot by itself show that typical human exposure causes cardiovascular disease.
The research team is continuing to examine how food additives and ultra-processed foods may influence inflammation, oxidative stress, metabolic markers in the blood, and the composition of the gut microbiota.
What the Study Cannot Tell Us
The study has several important limitations:
It was observational. Researchers tracked what participants ate; they did not randomly assign people to consume particular preservatives.
Residual confounding is possible. Even a carefully adjusted model cannot capture every behavior, food combination, or health difference.
The cohort was not representative of everyone. Participants were mostly women and tended to be more highly educated and health-conscious than the general French population.
Diet was self-reported. The repeated, brand-specific records were unusually detailed, but no dietary survey is perfect.
Some hypertension may have been missed. People with undiagnosed high blood pressure would not necessarily appear as cases.
The findings need replication. The authors described this as the first prospective epidemiological study to examine such a broad range of preservative additives and cardiovascular outcomes.
What Should You Do With This Information?
There is no need to empty your pantry or fear every unfamiliar ingredient. A more useful response is to reduce repeated exposure where doing so is practical.
Read the Ingredient List
U.S. food labels generally list ingredients by their common names and in descending order by weight. Chemical preservatives must be declared under federal labeling rules, although ingredients present at 2% or less may be grouped near the end. The details are set out in 21 CFR §101.4.
Compare Products You Buy Frequently
If two similar breads, dressings, drinks, or meat products meet your needs, compare their ingredient lists. Choosing the option without a particular preservative can reduce exposure without requiring an all-or-nothing diet overhaul.
Compare like with like. A shorter ingredient list is not automatically healthier, and an ingredient's position does not reveal your exact dose. Look at the whole product—its sodium, added sugar, saturated fat, fiber, serving size, and how often you eat it—not one additive in isolation.
Focus on the Overall Eating Pattern
When accessible and appropriate for you, make vegetables, fruit, beans, plain grains, nuts, and simply prepared proteins the foundation of most meals.
Frozen and canned foods can still be nutritious choices. “Processed” is a broad category, not an automatic verdict, and some processing improves safety, convenience, affordability, or shelf life.
Reduce Repetition Rather Than Chasing Perfection
The study examined long-term intake patterns, not a single meal. Start with packaged foods you eat most often. Rotating brands or replacing one frequently consumed product may be more realistic than trying to eliminate every preservative at once.
Keep Established Heart-Health Priorities in View
Blood pressure and cardiovascular risk are influenced by many factors, including sodium intake, smoking, physical activity, sleep, alcohol, genetics, and access to medical care.
Reducing additive exposure can complement those better-established priorities, but it should not replace them. If you have hypertension, cardiovascular disease, food allergies, or medically necessary dietary restrictions, discuss major changes with a qualified healthcare professional.
Frequently Asked Questions
Does this study mean vitamin C or citrus fruit is bad for the heart?
No. The researchers estimated exposure to ascorbic acid and citric acid when used as food additives. The study did not find that oranges, lemons, berries, peppers, or other naturally vitamin C-rich foods cause hypertension.
Should I avoid every food containing one of these additives?
The research does not support an all-or-nothing rule. It found statistical associations across long-term intake groups, not proof that an occasional serving causes harm. Comparing products you consume regularly is a more proportionate response.
How can I identify these additives on a U.S. food label?
Check the ingredient list for the full names: potassium sorbate, potassium metabisulfite, sodium nitrite, ascorbic acid, sodium ascorbate, sodium erythorbate, citric acid, and rosemary extract. U.S. labels generally do not rely on the European E-numbers.
The Bottom Line
This large study revealed several associations between widely consumed preservative additives and a higher incidence of hypertension or cardiovascular disease. Its detailed dietary data make the findings worth taking seriously.
The results do not prove that an occasional food containing potassium sorbate, citric acid, or rosemary extract will damage your heart. They do provide a credible reason for researchers and regulators to examine long-term exposure more closely.
For consumers, the most reasonable takeaway is neither panic nor dismissal: check labels, vary the packaged foods you rely on, and let minimally processed foods do more of the everyday work in your diet.
