Food insecurity raises risk for poor outcomes in patients with PAD
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CHICAGO — Among patients with peripheral artery disease, those with food insecurity had elevated risk for a major CV event, researchers reported at the American Heart Association Scientific Sessions.
Rayan S. El-Zein, DO, researcher at Saint Luke’s Mid America Heart Institute at the University of Missouri-Kansas City in Kansas City, Missouri, and colleagues analyzed 11,907 adults treated for PAD in the Saint Luke’s Health System between 2015 and 2021. They determined food access status via the U.S. Department of Agriculture’s Food Access Research Atlas.
“For a very long time, there has been extensive knowledge on the impact of healthy dietary habits on cardiometabolic health,” El-Zein told Healio. “However, identifying barriers that are preventing patients from being able to achieve those dietary goals to begin with is also critically important, particularly to mitigate health inequities faced by patients with PAD. Food insecurity directly impacts patients’ ability to improve their cardiometabolic health and is a key determinant that needs to be addressed in order to improve patient care in PAD.”
Among the cohort, 15.4% lived in a food desert. Compared with those not living in a food desert, those living in a food desert had increased risk for major adverse CV events, defined as all-cause death, acute MI or stroke (HR = 1.17; 95% CI, 1.04-1.31; P = .008), El-Zein and colleagues found.
The results were driven by all-cause death (HR = 1.19; 95% CI, 1.03-1.37; P = .018), according to the researchers.
“Individuals with PAD who live in food deserts — which are areas with low income and poor access to healthy foods based on distance to grocery stores — have an increased risk of death,” El-Zein told Healio.
The researchers also assessed the cohort for receipt of guideline-directed optimal medical therapy, which has been shown to reduce major adverse CV events. The following factors were associated with lower odds of receiving optimal medical therapy: female sex, malnutrition, chronic kidney disease, chronic obstructive pulmonary disease and low area income.
“The ability of a patient to achieve optimal medical therapy — in the PAD population, defined as an antiplatelet, a statin, a renin-angiotensin inhibitor, and tobacco abstention — is reduced in those who live in low-income areas,” El-Zein told Healio. “Patients with PAD who live in food deserts have major barriers to obtaining appropriate treatments that improve their outcomes.
“Doctors need to do a better job at screening patients for food insecurity,” he said.
“There are several screeners that are validated, including the USDA Household Food Security Survey Module and the Hunger Vital Sign, which both can be used clinically and effectively.”
Once screening is performed, “doctors need to offer nutritional counseling to patients and provide them with resources to combat their food insecurity,” he said.
Also, “On a health-system level, we need to advocate for health policies and partnerships that connect patients with community-based initiatives which combat food insecurity on a local context. This includes, but not limited to, resources on community gardens, food pantries, farmers’ markets and home-delivered medically tailored meals,” El-Zein told Healio. “On a statewide and national level, we can also advocate for patients to receive federal assistance from sources such as the [Supplemental Nutrition Assistance Program] and the [Special Supplemental Nutrition Program for Women, Infants and Children], which have been shown to improve food insecurity.”
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El-Zein RS, et al. Abstract SU3070. Presented at: American Heart Association Scientific Sessions; Nov. 5-7, 2022; Chicago (hybrid meeting).
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