Two white crystals to avoid for cardiovascular health

A study on the impact of sugar on cardiovascular disease that appeared Dec. 12, 2014,1 in the scientific journal Open Heart has received widespread coverage by traditional media, but the conclusion should be placed in context.

The review paper, titled, “The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease,” examines the role of fructose in hypertension, or high blood pressure, which is the most important risk factor for cardiovascular disease. 

For years, patients with hypertension have been advised to avoid processed foods because of their salt content. In the review, co-authors James DiNicolantonio, MD, and Sean Lucan, MD, MPH, assert that it is more likely to be the sugar in processed foods, rather than salt, that drives hypertension. They conclude that dietary guidelines should emphasize the role played by added sugars to curb the prevalence of cardiovascular disease. 

We agree on the main message in this work, as it builds on the considerable body of evidence linking added sugars to hypertension and cardiovascular disease, the No. 1 cause of premature death in the developed world. But many news reports have made it look as though salt is, suddenly, no longer a problem. In fact, significant research has shown that salt is very much a factor in raising the risk of hypertension. The review paper correctly highlights our growing understanding of the role of fructose in cardiovascular disease. But hypertension, as with many health conditions, is a complex problem with multiple causes. Salt remains a significant one of those factors.

The important extension of this work is that limiting both added sugar and salt are important for heart health.  In the US, processed foods are the major source of both added sugar and salt in the diet. Fortunately for people concerned about their heart health, limiting processed food in the diet very likely has the effect of reducing both of these additives and improving heart health.

  • [1]DiNicolantonio, J.J., & Lucan, S.C. (2014, December 10). The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. Open Heart , 1(1). doi:10.1136/openhrt-2014-000167. Retrieved from

Added sugar

Any sugar added in preparation of foods, either at the table, in the kitchen or in the processing plant. This may include sucrose, high fructose corn syrup and others.

SugarScience Glossary


Sugars are chemicals made of carbon, hydrogen, and oxygen found which taste sweet and are found in food. They are an important part of what we eat and drink and of our bodies. On this site, sugar is used to mean simple sugars (monosaccharides) like fructose or glucose, and disaccharides like table sugar (sucrose). Sucrose is two simple sugars stuck together for example (see Table sugar). Sugars are a type of carbohydrate. Carbohydrates are energy sources for our bodies Sugars enter the blood stream very quickly after being eaten.

SugarScience Glossary


A sugar that we eat. Also called fruit sugar. Most fructose comes in sucrose (table sugar, cane sugar, beet sugar), or from high-fructose corn syrup.

SugarScience Glossary

SugarScience is the authoritative source for evidence-based, scientific information about sugar and its impact on health.

Kirsten Bibbins-Domingo, MD, PhD, MAS

Kirsten Bibbins-Domingo, MD, PhD, MAS, is a cardiovascular epidemiologist with expertise in the development of cardiovascular disease, chronic kidney disease and diabetes risk in young adults. She is the Vice Dean for Population Health and Health Equity in the UCSF School of Medicine.

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