The Hidden Ways Sugar Affects Your Heart

Sugar is easy to dismiss as a harmless indulgence, in part because of how prevalent it is in what cardiologist Andrew Freeman, MD, calls the “standard American diet.” It shows up in coffee, snacks, sauces and drinks. Sometimes these amounts feel too small to matter. But according to Dr. Freeman, those everyday exposures can quietly accumulate, placing real stress on the heart and blood vessels over time.

“Added sugars are a major problem because they’re a source of excess calories,” Dr. Freeman said. “And when the body can’t process it as well, it typically results in insulin resistance and then eventually diabetes down the road.”

Overconsuming sugar has been linked to the development of cardiometabolic disease, an umbrella term used to describe a group of closely related conditions, including: 

These conditions share common underlying drivers, particularly chronic inflammation and impaired metabolic function. Regularly consuming high amounts of added sugar can overload the body’s ability to regulate blood sugar, promote insulin resistance and damage blood vessels over time. As these effects build up, the risk of developing problems with blood sugar and metabolism. 


Why Sugar and Heart Disease Are So Closely Linked

From a cardiology standpoint, excess sugar does more than contribute to weight gain. Dr. Freeman explains how sugar directly damages blood vessels and accelerates disease. “Excess sugar in the blood is a direct toxin to blood vessels and the heart,” he said. Repeated spikes in blood sugar can fuel inflammation, disrupt normal blood vessel function and increase the risk of: 

While these conditions are often treated as separate problems, Dr. Freeman emphasized that they are closely connected and increasingly understood as different expressions of cardiometabolic disease.

“We’re trying to look at excess sugar or diabetes as one problem,” he said. “But really, all of it is starting to meld into the same thing.” That growing understanding helps explain why newer medications originally developed for diabetes are now improving outcomes in heart failure and cardiovascular disease. Still, Dr. Freeman stressed that prevention begins long before medication is needed, and food choices play a central role.


Hidden Sugars in Everyday Foods

One of the biggest challenges for consumers is recognizing how much sugar they are actually eating, since it rarely appears in obvious ways. Food manufacturers often break sugar into multiple ingredients, each listed under a different name. These can include: 

  • Cane sugar
  • Evaporated cane juice
  • Fructose
  • Corn sugar 

“In many foods, especially things that we feed to our kids, you’ll see three or four or five ingredients in the first five that are all sugar, just described differently,” Dr. Freeman said. Even foods marketed as healthy or fruit-based can contain significant amounts of added sugar.  This can make it harder for people to understand what they are really consuming.

Dr. Freeman encourages shoppers to look beyond front-of-package claims and focus on the nutrition label, particularly the line that lists added sugars. “If you’re looking at things that have added sugars of any amount, you really should consider skipping them altogether,” he said. At the same time, he noted that sugar found naturally in whole foods behaves differently in the body. “Nature is much smarter than we are,” Dr. Freeman said. He explained that fiber, water and other components in fruit slow sugar absorption and reduce blood sugar spikes. “If I eat a piece of candy, my sugar might spike,” he said. “But if I eat a strawberry, even a sweet strawberry, my sugar may not spike as much, if at all.”

For people trying to cut back on sugar, artificial sweeteners can seem like an easy fix, but Dr. Freeman urges caution. “Artificial sweeteners are now under significant investigation by scientists,” he said. Studies have raised concerns about how certain sweeteners may affect platelets, which play a role in blood clotting and coronary disease. While not all sweeteners carry the same level of concern, Dr. Freeman says it is a mistake to assume that “sugar-free” automatically means heart-healthy. 

Sugar-sweetened beverages remain a major contributor to excess sugar, and artificially sweetened drinks can also pose problems. “What I’m telling people right now is to drink water, unsweetened tea and unsweetened coffee. Skip everything else,” Dr. Freeman said. 

Rather than obsessing over every label, Dr. Freeman recommends a simpler approach. “The best thing people can do is use packaged foods extremely sparingly,” he said, advising that the majority of your grocery shopping should be done on the edges of the supermarket, where whole foods like fruits and vegetables can be found.  Opting for a whole foods, plant-based diet can be a great step toward reducing your risk of heart disease. 

The rise of heart disease is one of today’s most pressing health challenges, but Freeman believes people still have meaningful power to protect themselves. “Living healthy is a great way to reduce that burden,” said Dr. Freeman. “Being smarter consumers and avoiding unnecessary sugar is a really powerful way to improve health.”