Food insecurity among Black adults independent risk factor for heart disease
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Economic food insecurity is a risk factor for incident CHD and incident HF with reduced ejection fraction, independent of socioeconomic measures and traditional CV risk factors, researchers reported.
In an analysis of participants in the Jackson Heart Study, researchers also found that participants experiencing economic food insecurity had greater systemic inflammation and had greater neurohormonal activation, both pathways that are implicated in atherosclerosis and HF.
Data were derived from Zierath R, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2022.52055.
“Social determinants of health importantly impact the risk for CVD and disproportionately burden Black Americans,” Amil M. Shah, MD, MPH, associate professor of medicine at Harvard Medical School and associate physician in the division of cardiovascular medicine at Brigham and Women’s Hospital, told Healio. “This analysis demonstrates that economic food insecurity is a risk factor for incident CHD and HF, particularly HF with reduced ejection fraction, even after accounting for traditional CV risk factors. Importantly, these associations also persisted after accounting for measures of socioeconomic status, suggesting that the impact of food insecurity extends beyond economic disadvantage.”
Shah and colleagues analyzed data from 3,024 Black adult participants in the Jackson Heart Study without prevalent CVD at baseline (2000-2004). The mean age of participants was 54 years; 66% were women. Researchers defined economic food insecurity as receiving food stamps or self-reporting not having enough money for groceries, and high frequency (> 2.5) of unfavorable food stores (fast food restaurants, convenience stores) within 1 mile. The main outcomes were incident CVD, including incident CHD, stroke, HF with preserved EF and HFrEF. Median follow-up was 13.8 years.
The findings were published in JAMA Network Open.
Within the cohort, 21% of participants were considered economically food insecure and 50% had more than 2.5 unfavorable food stores within 1 mile.
In analyses adjusted for CV risk and socioeconomic factors, researchers found that economic food insecurity was associated with higher risk for incident CHD (HR = 1.76; 95% CI, 1.06-2.91) and incident HFrEF (HR = 2.07; 95% CI, 1.16-3.7), but not stroke or HFpEF. The associations persisted after adjustment for diet quality and perceived stress.
Economic food insecurity was also associated with higher high-sensitivity C-reactive protein and renin concentrations.
A high frequency of unfavorable food stores was not associated with CVD risk.
“Our findings highlight the importance of greater screening and recognition of food insecurity, and adverse social determinants of health more broadly, by clinicians to better appreciate an individual’s risk for CV events,” Shah told Healio. “It also provides yet another reason for health care providers to support policies to address food insecurity.”
For more information:
Amil M. Shah, MD, MPH, can be reached at ashah11@rics.bwh.harvard.edu; Twitter: @amilmshah.
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