Study Suggests Connection Between Economic Food Insecurity, CVD Risk in Black Adults

Amil M. Shah, MD, MPH

Economic food insecurity is a risk factor for incident coronary heart disease (CHD) and heart failure with reduced ejection fraction (HFrEF) in Black adults in the United States, according to an analysis of the Jackson Heart Study.

The research suggests the risk persisted even after accounting for traditional cardiovascular risk factors and socioeconomic status, such as income and educational attainment.

“These findings support economic food insecurity, which disproportionately affects Black communities, as an important factor in the well-documented racial disparities in CV health, and as a promising potential target for intervention,” wrote corresponding author Amil M. Shah, MD, MPH, Division of Cardiovascular Medicine, Brigham and Women’s Hospital.

Food inadequacy often occurs due to a lack of physical access to nutritious foods, referred to as food deserts or swamps, and affects approximately 13.5 million people across the US. Evidence suggests that food insecurity and limited food access are associated with prevalent hypertension, diabetes, and obesity, particularly in communities with a majority of Black residents.

Both food insecurity and low diet quality have been linked to cardiovascular comorbidities and HF risk factors, suggesting a connection between diet and the development of comorbidities among the food insecure.

The current cohort study was a time-to-event analysis of 3024 Black adult participants without CVD in the Jackson Heart Study initially recruited for a first study visit between 2000 and 2004 in Mississippi. Data analysis was conducted by investigators from September 2020 to November 2021.

Economic food insecurity was assessed via self-report at the first study visit and defined in the analysis as receiving food stamps in the past year. Patients were additionally asked to rate the severity of stress they felt regarding having enough money for basics, including food. Unfavorable food stores were defined as convenience stores and fast-food restaurants within 1 mile, with ≥2.5 locations considered high.

Participants in the Jackson Heart Study were followed up for CV events, deaths, and loss to follow-up since the baseline examination in 2000-2004. The associations of economic food insecurity and incident CV events were assessed using multivariable Cox proportional hazard regression models adjusted for baseline demographic characteristics, comorbidities, and socioeconomic status.

In the analysis, the study sample was made up of 3024 adults free of HF and CHD at baseline who had adequate food store and food insecurity data. Compared with those who were not economically food insecure, individuals experiencing economic insecurity were younger, more likely to be women, and had a higher prevalence of hypertension and greater BMI.

Models adjusted for demographic characteristics show economic food insecurity was associated with a heightened risk of incident CHD, incident HF, and incident HFrEF. There was no association seen between economic food insecurity and incident HFpEF or incident stroke.

Analyses adjusted for cardiovascular and socioeconomic factors revealed economic food insecurity was associated with higher risk of incident CHD (hazard ratio [HR], 1,76; 95% CI, 1.06 - 2.91) and incident HFrEF (HR, 2.07; 95% CI, 1.16 - 3.70).

The associations continued after further adjustments for physical activity, smoking, diet quality, and perceived stress. Demographic analyses additionally indicate economic food insecurity was linked to higher high-sensitivity C-reactive protein and renin concentrations.

Multivariable cox proportional hazards regression models suggest a high frequency of unfavorable food stores within 1 mile were not associated with CHD, HF, or stroke. No associations were observed after adjustment for clinical comorbidities and socioeconomic status.

“Our findings are observational, and further prospective intervention studies are needed to define whether intervening on economic food insecurity will yield reductions in risk of CHD and/or HFrEF,” Shah wrote. “However, our findings provide a rationale to expect that targeting food insecurity could reduce incident CHD and HF and help mitigate the marked racial disparity in the burden of CVD in the US.”

The study, “Measures of Food Inadequacy and Cardiovascular Disease Risk in Black Individuals in the US From the Jackson Heart Study,” was published in JAMA Network Open.