Sugar isn’t usually top of mind when it comes to heart health — but it should be. Along with more well-known dietary culprits, like sodium and saturated fat, there’s increasing evidence that eating too much sugar can be harmful to your heart.

Added sugar, in particular, appears to be linked to negative impacts. From raising “bad” cholesterol levels to increasing your risk of diabetes and obesity, which are both risk factors for cardiovascular disease, here’s what you need to know about how sugar can affect your heart health.

Research suggests that a diet high in “free sugars” — sugars added to foods or sugars naturally found in fruit juices, honey, and syrup — may increase your risk of heart disease and stroke.One study, for example, looked at the eating habits of more than 110,000 people from the United Kingdom over a nine-year period. Scientists found that for every 5 percent increase in a person’s intake of free sugars consumed, the risk of developing heart disease was 6 percent higher and the risk of having a stroke was 10 percent higher.“Studies have shown an association with increased sugar intake with adverse effects on lipoproteins,” says David Cork, MD, a board-certified cardiologist at Scripps Clinic in La Jolla, California.When your liver processes too much excess sugar, it produces more triglycerides, Dr. Cork explains. It may also create less HDL (“good”) cholesterol and more LDL (“bad”) cholesterol. This is associated with coronary artery disease, peripheral arterial disease, and stroke.Consuming too much sugar is also linked to developing cardiovascular disease risk factors, like type 2 diabetes and obesity. People who have diabetes are twice as likely to have a stroke as those who do not, and they’re more likely to develop heart disease or have a stroke earlier in life.

To understand the link between sugar and cardiovascular disease, it’s helpful to understand what’s happening inside the body when you get too much sugar through your diet.

Blood Vessel Issues

Consistently eating a high amount of processed sugar can damage the lining of your blood vessels over time.

“Excess sugar can be associated with the promotion of accelerated atherosclerosis (plaque buildup inside the walls of the blood vessel),” Cork says. “Which can ultimately cause narrowing of critically important arteries providing blood flow to the heart, brain, extremities, or other organs.”

Insulin Resistance

“Whenever we have excess sugar floating around in our bloodstream, our body responds to that by releasing insulin,” explains Matthew Landry, PhD, RDN, a member of the American Heart Association (AHA) Nutrition Committee and assistant professor of population health and disease prevention at the University of California, Irvine.

When your body is constantly having to use insulin to bring your blood sugar down, you can develop insulin resistance. “That’s a key risk factor for type 2 diabetes,” Dr. Landry says.

Elevated blood sugar, which occurs in people with unmanaged diabetes, can cause high blood pressure, which puts a strain on the heart. Obesity also raises blood pressure and causes fat buildup in the arteries, a risk factor for stroke and heart attack.

Inflammation

“There’s some more emerging evidence showing that having that excess sugar can increase systemic inflammation throughout the body,” Landy says.“Increased sugar levels have been shown to be associated with the development of obesity, which is an inflammatory state,” Cork says. “Some studies have shown obesity to be associated with increased risk of congestive heart failure and coronary artery disease event rates.”

The average American adult eats 17 teaspoons of added sugar a day — that’s 57 pounds a year — nearly three times the amount recommended by the AHA.The AHA advises limiting added sugar to no more than 6 percent of your daily calories. In a standard 2,000-calorie diet, that works out to be about 6 teaspoons (24 grams) of sugar.

Sugar is generally safe for most people to eat in moderation. Instead of trying to cut it out of your diet entirely, Landry recommends starting to pay closer attention to your daily intake.

“Now on the back of food packages, they have to list if there’s added sugar,” he says. This can help you understand your overall intake, and find opportunities to make lower-sugar swaps. A surprising amount of sugar can be found in products like salad dressings, fruit juices, and more.

Aim to eat an overall balanced diet low in sodium and saturated fat and rich in whole foods and fiber to support heart health.

What About Artificial Sweeteners?

Some sweeteners may also contribute to heart disease. One observational study investigated the potential impact artificial sweeteners had in more than 100,000 people.

They found that regularly consuming aspartame in particular — which accounted for nearly 60 percent of artificial sweetener intake among participants — was associated with increased risk of stroke. Two other artificial sweeteners, acesulfame potassium and sucralose, were linked to increased risk of coronary heart disease.

Overall, people who consumed significant amounts of artificial sweeteners had a nearly 20 percent higher risk of stroke and other cerebrovascular incidents, which block blood flow to the brain, and a nearly 10 percent increase in risk of cardiovascular disease.

• Consistently high intake of added sugars can impact heart health by increasing the risk of heart disease, stroke, and associated cardiovascular ailments.

• Excess sugar prompts your liver to produce more LDL cholesterol and lower levels of HDL cholesterol, which can lead to arterial damage and elevated risk of strokes and heart attacks.

• Limiting added sugar to no more than 6 percent of your total daily calories is recommended, meaning about 6 teaspoons in a 2,000-calorie diet for most people.

• Eat a balanced diet that is low in saturated fat and sodium to help support cardiovascular health.