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Income influences CV risk in urban ‘food deserts’
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Area income and individual income were major factors in the increased burden of CV risk factors and preclinical signs of CVD in patients who lived in “food deserts,” according to a cross-sectional analysis published in Circulation: Cardiovascular Quality and Outcomes.
“At least in the urban environment, the definition of a food desert wasn’t sufficient to explain poor health in terms of cardiovascular risk factors,” Arshed A. Quyyumi, MD, FACC, FRCP, professor of medicine at Emory University School of Medicine and co-director of the Emory Clinical Cardiovascular Research Institute, said in a press release. “This study shows that low personal income and low socioeconomic status matter when it comes to cardiovascular disease risk. Physicians need to be aware that these social determinants increase disease risk and that perhaps more attention needs to be paid to patients who fall into this category.”
Atlanta food deserts
Heval M. Kelli, MD, of the Emory Clinical Cardiovascular Research Institute, and colleagues analyzed data from 1,421 participants (mean age, 49 years; 39% men; 37% black) from the META-Health study (n = 712) and the Predictive Health study (n = 709) who lived in the Atlanta metropolitan area. Pregnant women and those with acute illness, poorly controlled medical conditions or recent hospitalizations were excluded.
Ten-year risk for MI or coronary death was estimated by atherosclerotic CVD scores. ZIP codes for each participant were entered into an FDA research atlas to determine the food desert status. Blood tests were also performed to measure total cholesterol, glucose, LDL, HDL, serum high-sensitivity C-reactive protein levels and markers of oxidative stress.
Compared with participants not living in food deserts (n = 1,234; mean age, 49 years; 38% men; 34% black), those living in food deserts (n = 187; mean age, 49 years; 39% men; 52% black) had higher prevalence of hypertension (47.6% vs. 32.4%; P < .001) and smoking (21.9% vs. 12.4%; P < .001). Participants living in food deserts also had higher BMI (30.6 kg/m2 vs. 28.6 kg/m2; P < .001), fasting blood glucose levels (94.8 mg/dL vs. 91.2 mg/dL; P = .042) and atherosclerotic CVD score (4.1 vs. 2.8; P = .007).
The food desert group had higher levels of high-sensitivity CRP (2.2 mg/L vs. 1.5 mg/L; P = .014) and augmentation index (23.09 vs. 21; P = .015) and lower glutathione levels (1.51 µmol/L vs. 1.67 µmol/L; P = .003) vs. the non-food desert group.
Income in food deserts
CVD risk measures were linked to area income and individual income, but not food access. Low individual household income and low-income areas were independent predictors of a high 10-year risk score in a multivariate analysis that included area income, individual income and food access. A higher augmentation index and high-sensitivity CRP was independently predicted by low individual income.
“The implications of our findings are that at least in urban areas, risk of CVD seems to be associated less with access to healthy food and more with socioeconomic factors,” Kelli and colleagues wrote. “This understanding may help to better tailor resources to affected communities and improve utilization of public health resources.”
“Neighborhood effects can go beyond food deserts also,” Keith C. Ferdinand, MD, professor of medicine at Tulane University School of Medicine and Cardiology Today Editorial Board Member, and Indrajeet Mahata, MD, cardiovascular disease fellow at Tulane University School of Medicine, wrote in a related editorial. “A large burden of CVDs can be prevented through lifestyle changes such as tobacco avoidance, engaging in physical activity and maintaining a healthy weight. In addition, communities may help with controlling chronic conditions such as elevated blood pressure, diabetes mellitus and elevated lipid levels. Certain neighborhoods are not conducive for outdoor activities and hence do not promote health.” – by Darlene Dobkowski
Disclosure: The authors and Mahata report no relevant financial disclosures. Ferdinand reports he is a consultant for Amgen, Boehringer Ingelheim, Novartis, Quantum Genomics and Sanofi.
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