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Living in food deserts confers elevated CV risk in CAD
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Increased risk for adverse CV events in adults with CAD is associated with living in food deserts, with adults living in low-income areas having significantly worse outcomes, according to findings published in the Journal of the American Heart Association.
Heval M. Kelli, MD, of the division of cardiology, department of medicine at Emory University, and colleagues assessed the effect of living in food deserts on adverse CV events using a cohort of patients with suspected or confirmed CAD.
“Given our prior work showing that area income drives the unfavorable cardiovascular disease risk profile and disease burden, we hypothesized that living in [a food desert] would be an independent risk factor of adverse cardiovascular outcomes, independent of the traditional risk factors, and it would be largely driven by low area income, not the level of access to food,” Kelli and colleagues wrote.
The study comprised 4,944 adults (mean age, 64 years; 64% men; 22% black) who underwent cardiac catherization in the Emory Cardiovascular Biobank. Outcomes of interest were MI and death. Median follow-up was 3.2 years.
According to Kelli and colleagues, 20% of participants lived in a food desert and had a higher adjusted risk for MI (subdistribution HR = 1.44; 95% CI, 1.06-1.95) compared with participants not living in food deserts.
In a multivariate analysis including food access and area income, only living in low-income areas was associated with higher adjusted risk for MI (subdistribution HR = 1.4; 95% CI, 1.06-1.85) and death/MI (HR = 1.18; 95% CI, 1.02-1.35), whereas living in a poor-access area was not significantly associated with either (subdistribution HR for MI = 1.05; 95% CI, 0.8-1.38; HR for death/MI = 0.99; 95% CI, 0.87-1.14).
“The reasons for the risk posed by low-income areas in patients with CAD need further exploration,” Kelli and colleagues wrote. “This realization may help refine and better navigate governmental and nongovernmental resources to low-income areas.” – by Earl Holland Jr.
Disclosures: Kelli reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Keith C. Ferdinand, MD, FACC, FAHA, FNLA, FASH
The concept of food deserts defines people who don’t have access to healthy foods, and usually, that would be disadvantaged populations in urban settings less than a mile and in rural settings greater than 10 miles.
However, it’s always been a question, ‘how do you separate this concept of food deserts from the concept of disadvantaged socioeconomic environments unrelated to simple food access?’
So, this study attempted to tease out what component of the food desert concept was most important in terms of predicting CV events.
Well, I think it’s clear that simply having a supermarket or access to healthy foods is not going solve the problem of high levels of CV events in low socioeconomic environments.
The social determinants of health are real, but it’s a mixture of various conditions and not simply having less access to healthy foods.
One of the reasons why it’s important to recognize that healthy food access itself is not going to be the final defining factor is because people must make positive choices.
There have been some data to indicate, for instance, in the southeastern part of the United States that one of reasons for the higher rates of hypertension and stroke are food choices in the so-called “Southern diet,” consisting of fried foods and foods with a high-sodium content.
So even if there were, for instance, a supermarket with appropriate foods available, patients would have to be educated on what are healthy eating patterns such as the DASH eating plan and the Mediterranean-style diet.
Then, after being educated about these would have to have ways to accept them in a culturally appropriate matter.
There have been some efforts to make a DASH-Southern diet with appropriate modifications such that they would be desired and accepted by patients.
For clinical practice, I don’t think it’s enough for CV specialists including cardiologists, internists and nurse practitioners to simply wait for patients to have acute events or develop HF before we make efforts for prevention. Prevention and education must start prior to the manifest presence of CVD.
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