There is currently a situation that needs to be carefully balanced regarding the suitability of erythritol for populations with cardiovascular and cerebrovascular diseases: it has significant potential benefits, but there is also an important controversial study pointing out potential risks (which have not yet been conclusively determined). The following is a comprehensive analysis:

Potential benefits (supporting the use side)
Not raising blood sugar and insulin:

This is the biggest advantage. Patients with cardiovascular and cerebrovascular diseases are often associated with diabetes, insulin resistance or metabolic syndrome. Erythritol has almost no effect on blood sugar and insulin levels, and is crucial for controlling blood sugar. Good blood sugar control itself can help reduce cardiovascular risk.
Zero calorie/extremely low calorie:

Helps to control weight and overall calorie intake. Obesity is an important risk factor for cardiovascular and cerebrovascular diseases. Replacing sucrose with it can reduce unnecessary calorie intake and facilitate weight management.
Not causing dental caries:

There is a correlation between oral health and overall health (including cardiovascular health) (periodontal disease is one of the risk factors for cardiovascular disease).
Replace high calorie added sugar:

Excessive intake of added sugar (especially sucrose and fructose syrup) is recognized as an important factor leading to obesity, diabetes and dyslipidemia (such as hypertriglyceride), which directly increases the risk of cardiovascular and cerebrovascular diseases. Erythritol provides a satisfying sweet taste and is an effective tool for reducing the intake of added sugars.
Main controversies and potential risks (cautious side)
Warning from the 2023 Nature Medicine study:

Research core findings:
High levels of erythritol in the blood are significantly associated with an increased risk of major adverse cardiovascular events (such as myocardial infarction, stroke, and death) within the next 3 years in high-risk populations for cardiovascular disease and those undergoing cardiac examinations.
In vitro and animal experiments have shown that erythritol may promote platelet aggregation (platelets are key cells for thrombus formation) and accelerate thrombus formation.
Limitations and controversial points of the research (very important!):
Observational study, non causal proof: This study can only indicate that high levels of erythritol in the blood are associated with an increased risk of cardiovascular events, but cannot prove that erythritol intake directly leads to cardiovascular events. High levels of erythritol in the blood may only be a sign or result of high risk of cardiovascular disease (for example, metabolic disorders may lead to increased endogenous erythritol production), rather than the cause.
Special subjects: the study is mainly aimed at people who have cardiovascular disease risks (such as diabetes, hypertension, atherosclerosis) or are undergoing cardiac assessment. The results cannot be directly extended to the general population with cardiovascular health.
The blood source is not clearly distinguished: most of the ingested erythritol is rapidly absorbed and excreted through the kidneys, with a short residence time in the blood (peak 1-2 hours after intake, cleared within a few hours). In research, fasting blood samples are usually measured, and their erythritol levels are more likely to reflect the levels produced by endogenous metabolism in the body, rather than directly reflecting exogenous dietary intake. The researchers themselves also pointed out that more research is needed to determine whether dietary intake affects long-term blood levels.
Dose issue: The blood concentration in the study is much higher than the short-term peak concentration that may be achieved after normal consumption of erythritol containing food and beverages. The concentration used in vitro experiments is also very high.
Single study: This is the first time this association has been reported in a large population and has not been extensively replicated by other independent studies.
The current attitude of FDA/JECFA and other institutions:

At present, the major regulatory agencies worldwide (FDA, EFSA, JECFA, China National Health Commission) have not changed their conclusions on the safety of erythritol as a food additive due to this study. They believe that the existing evidence is insufficient to overturn the previous assessment, but will still closely monitor subsequent research.
Authoritative institutions generally believe that more targeted research (especially high-quality randomized controlled trials and longer-term observational studies) is needed to verify this association and explore causal relationships.
Suggestions for people with cardiovascular and cerebrovascular diseases (practical guidance after weighing)
Don't panic, but be vigilant: Based on current evidence, it is not recommended for high-risk individuals with cardiovascular and cerebrovascular diseases to completely panic and avoid erythritol, but they should be more cautious than healthy individuals.
The principle of moderation is crucial:
Strictly control intake: Even sugar alcohols that were previously considered safe may cause discomfort (such as diarrhea) if consumed in excess. Based on new research, it is recommended to strictly control intake for individuals with cardiovascular and cerebrovascular diseases. Avoid single or long-term large intake of foods and beverages containing erythritol.
Read food labels: Pay attention to the sweetener ingredients in sugar free foods and understand the content of erythritol.
Prioritize the overall dietary pattern: The key to cardiovascular and cerebrovascular health lies in the overall healthy dietary pattern (such as DASH diet, Mediterranean diet), emphasizing fruits, vegetables, whole grains, high-quality protein (fish, poultry, beans), healthy fats (olive oil, nuts), limiting saturated fats, trans fats, sodium, and all forms of added sugars (including sucrose and sugar substitutes). Don't neglect the overall quality of your diet just because you use sugar substitutes.
Individualized consultation with doctors or nutritionists:
If you are a patient with cardiovascular disease or a high-risk group (such as severe atherosclerosis, a history of myocardial infarction or stroke, diabetes with vascular complications, etc.), it is strongly recommended that you consult your attending doctor or registered dietitian.
They can provide personalized advice based on your specific condition (such as platelet function, coagulation status), medication use (especially antiplatelet/anticoagulant drugs), and dietary habits, evaluating the pros and cons of using erythritol in your situation.
Consider alternative sweeteners: If there are concerns, priority can be given to other natural sweeteners with longer safety records and relatively more friendly cardiovascular risk research as alternatives, such as:
Stevioside: extracted from plants, zero calorie, does not affect blood sugar. Numerous studies support its safety and may have neutral or mild beneficial effects on cardiovascular parameters such as blood pressure.
Siraitia grosvenorii glycoside: similar to stevia, plant extract, zero calorie, does not affect blood sugar, and has a good taste.
(Note: Any sweetener should be used in moderation)
summarize
For individuals with cardiovascular and cerebrovascular diseases, the suitability of erythritol is a matter that requires careful consideration:

The benefits are clear: it does not increase sugar and has zero calories, making it an ideal choice to replace harmful added sugars, especially beneficial for blood sugar control and weight management.
The risk is questionable but needs to be taken seriously: The 2023 study suggests potential risks of thrombosis and cardiovascular events. Although the level of evidence is limited and the causal relationship is unclear, the research subjects are precisely this population, so it must be highly vigilant.
Current suggestion:
Strict limit: significantly reduce intake and avoid consuming in large quantities.
Priority consultation for high-risk groups: For those with severe cardiovascular disease or high risk, it is necessary to consult a doctor or nutritionist before use.
Focus on overall diet: A healthy eating pattern is always at the core.
Consider alternatives: stevioside, siraitin, etc. can be selected as alternative sweeteners.
Until more high-quality studies, especially prospective studies and clinical trials targeting cardiovascular patients, reach clear conclusions, it is more prudent to adopt a "cautious limit" strategy for erythritol in populations with cardiovascular and cerebrovascular diseases. Pay close attention to the subsequent evaluation updates from authoritative institutions such as the FDA and the National Health Commission.