More research is needed to see how this factor could inform risk tools and whether addressing it reduces future disease.
Adults without enough to eat or access to quality food have a greater risk of developing cardiovascular disease over the next few decades, according to an analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study.
The elevated risk remained even after accounting for various demographic and socioeconomic factors (adjusted HR 1.41; 95% CI 1.03-1.92), researchers led by Jenny Jia, MD (Northwestern University Feinberg School of Medicine, Chicago, IL), report in a studypublished onlineWednesday in JAMA Cardiology.
The findings suggest “that food insecurity may be an important social deprivation measure in clinical assessment of CVD risk,” they write. “Whether interventions to reduce food insecurity programs can potentially alleviate CVD should be further studied.”
Food insecurity, the lack of either sufficient quality or quantity to support a healthy lifestyle, is estimated to affect about one in every eight Americans. It iseven more frequentin patients with atherosclerotic CVD, with the problem increasingover the last 20 years.
Though food insecurity has been associated with CVD and its risk factors, “there haven’t been a lot of studies to establish what direction the relationship is going in,” Jia told TCTMD. “Is it food insecurity that, as a socioeconomic stressor, is leading to heart disease or is it that heart disease as a chronic disease causes a socioeconomic stressor on the household [and leads] to food insecurity?”
She and her colleagues turned to the CARDIA study, which enrolled adults ages 18 to 30 living in four US cities in 1985 and 1986, to explore the question. The current analysis zeroed in on 3,616 participants (56% women) who provided information on food insecurity in 2000-2001, when their mean age was 40.1 years, and who had not had a CVD event previously.
At that time, 15% reported some level of food insecurity, and this group tended to be younger, had a lower education level, and were more likely to report being Black.
Through a mean follow-up of 18.8 years, participants who reported food insecurity were more likely to have a CVD event, which included fatal or nonfatal coronary heart disease, heart failure, stroke, TIA, or peripheral arterial disease (11% vs 6%). Food insecurity remained associated with a greater risk of incident CVD after adjustment for age, sex, race, study site, education, marital status, and usual source of medical care.
Multiple Reasons for Heightened Risk
There are multiple potential pathways leading from food insecurity to a risk of developing CVD years or decades later, Jia said. Lacking a sufficient quantity of food, or enough variety, can lead to a calorie deficiency, and “it is very hard to maintain healthier food intake in those situations,” she said.
People who are food insecure may be receiving various forms of assistance, which can lead to cycles of eating where food is more readily available at certain times of the month but in short supply during others. That, too, “causes an instability and can lead to some unhealthy dietary patterns,” Jia said.
Aside from dietary quality, however, the strain caused by food insecurity may also play into the relationship with CVD. “It’s likely that a household that is food insecure is dealing with other socioeconomic stressors as well, and the stress from those factors does also promote heart disease,” said Jia.
It’s likely that a household that is food insecure is dealing with other socioeconomic stressors as well. Jenny Jia
Effort to address food insecurity to help people “eat better is probably going to decrease the risk of heart disease,” she added. The expansion of interventions, such as the Supplemental Nutrition Assistance Program (SNAP), can help tackle food insecurity and may reduce the population risk of CVD, say the researchers.
They add, however, that additional research on SNAP or other programs “is needed to understand their role in cardiovascular prevention and addressing the root causes of health disparities.”
This week, the US Preventive Services Task Force released recommendations onscreening for food insecurityin primary care settings, stating that “the current evidence is insufficient to assess the balance of benefits and harms” of such screening across age groups.
Responding to that guidance in the context of the results of the current study, Jia said it’s yet unclear what to do with information that some people are struggling with getting enough quality food to eat and it may be influencing their future CVD risk. “Do we need to be exploring how we use these social determinants of health screeners? And do we take that information and use it for helping to refine disease risk? Those things need to be studied and new models need to be built and examined to see if they are better than our current conventional models, which tend to be more focused on the clinical measures—things like blood pressure, diabetes, cholesterol, and age.”