erythritol and possible increased risk of cardiovascular disease

came across this today…are these legit/acceptable studies? assume there will be several follow ups which will help verify/negate, but in the meantime would this suggest avoidance until more information become available?

The artificial sweetener erythritol and cardiovascular event risk | Nature Medicine
Our findings reveal that erythritol is both associated with incident MACE risk and fosters enhanced thrombosis.

This is the above content (without the paywall)
Non-nutritional sweeteners and cardiovascular risk | Nature Medicine

The artificial sweetener erythritol and cardiovascular event risk | Nature Medicine YDkmKtSZJOysYZlROr0ymfAdj9yPHH8bMVWpKjhPzPeMT8zTG9 DpNMmnfRfOqNqOH8PhwI2X9sxfHMa-Tpawl-dyIWq9WdTUO2lqDJWIHLoFK3aG5AGi1YhJA9wBG1MP6-JY2bDGUM7uqt1wx64p5HMOZY0cvojnNQ%3D%3D&tracking_re ferrer=www.cnn.com

Artificial sweetener linked to higher CVD risk | Nature Reviews Cardiology

The non-nutritive sweetener erythritol, a widely used sugar substitute, is associated with an increased risk of cardiovascular disease (CVD), including myocardial infarction and stroke, according to a study published in Nature Medicine.​

THANKS! the forum, site content, videos, podcasts, and seminars (2020) were/are/and continue to be incredibly valuable!

Short answer, no, erythritol ingestion as part of a health promoting dietary pattern does not increase risk of cardiovascular disease.

Long answer:

Links 1 and 3 are the same paper. Link 2 and 4 are separate reviews, not studies.

Erythritol is produced by a few pathways in the body, such as the pentose phosphate pathway. In folks with chronic medical conditions, blood levels of erythritol are increased via this pathway. This certainly muddies up a correlation between consumed erythritol and disease. This has been recognized as a marker of cardiometabolic disease for some time. None of the papers reviewed controlled for endogenous production vs consuming it in the diet.

In the only paper looking at what actually happens in humans, platelet activity was monitored. This study was not randomized, only had 8 people, and had 5 other outcomes that were noted on the trial registry, but not reported on. This reeks of BS.