Economic food insecurity is a risk factor for incidence of 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 that the risk persisted even after accounting for traditional cardiovascular risk factors and socioeconomic status, such as income and education.
“These findings support economic food insecurity, which disproportionately affects black communities, as a major 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.
Dietary inadequacy usually occurs due to lack of physical access to nutritious food, known as food deserts or swamps, and affects approximately 13.5 million people in the US. Evidence suggests that food insecurity and limited access to food are associated with prevalent hypertension, diabetes, and obesity, particularly in communities with a majority of black residents.
Both food insecurity and poor diet quality have been associated with cardiovascular comorbidities and risk factors for HF, 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 adult black participants without CVD in the Jackson Heart Study initially recruited for a first study visit between 2000 and 2004 in Mississippi. Data analysis was performed by the investigators from September 2020 to November 2021.
Economic food insecurity was assessed by self-report at the first study visit and defined in the analysis as receipt of food stamps in the previous year. Patients were also asked to rate how much stress they felt about 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.
Jackson Heart Study participants were followed for cardiovascular events, deaths, and loss to follow-up since the initial survey in 2000-2004. Associations of economic food insecurity and incident cardiovascular events were assessed using multivariate Cox proportional hazards regression models adjusted for baseline demographic characteristics, comorbidities, and socioeconomic status.
In the analysis, the study sample consisted of 3024 adults free of HF and CHD at baseline, who had adequate food storage and food insecurity data. Compared to those who were not economically food insecure, economically insecure individuals were younger, more likely to be female, and had a higher prevalence of hypertension and higher BMI.
Models adjusted for demographic characteristics show that economic food insecurity was associated with an increased risk of CHD incidence, HF incidence, and HFrEF incidence. There was no observed association between economic food insecurity and the incidence of HFPEF or stroke.
Analyzes adjusted for cardiovascular and socioeconomic factors revealed that economic food insecurity was associated with a 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 additional adjustments for physical activity, smoking, diet quality and perceived stress. Demographic analyzes further indicate that economic food insecurity was linked to higher concentrations of high-sensitivity C-reactive protein and renin concentrations.
Multivariate Cox proportional hazards regression models suggest that a high frequency of unfavorable food stocks within a 1-mile radius was not associated with CHD, HF, or stroke. No associations were observed after adjusting for clinical comorbidities and socioeconomic status.
“Our findings are observational and further prospective interventional studies are needed to define whether intervention in economic food insecurity will produce reductions in CHD and/or HFERHF risk,” Shah wrote. “However, our findings provide justification for hoping that addressing food insecurity may reduce the incidence of 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 open JAMA network.