Food Insecurity in US Tied to 41% Higher CVD Risk Over 2 Decades

A new cohort analysis of more than 3600 middle-aged US adults from the CARDIA study linked food insecurity to a raised risk of incident cardiovascular disease (CVD), which remained after adjustment for socioeconomic factors.1

Notably, food insecurity prevalence was 15% over the two-decade CARDIA study sample (2000–2020), compared with the 2000 national prevalence of 10%. Analysis of the cohort found food insecurity was correlated with a 41% higher risk of CVD after adjusting for age and sex.

“These findings suggest that food insecurity, like other markers of social deprivation, is associated with a higher rate of CVD events,” wrote the investigative team, led by Jenny Jia, MD, department of medicine, Northwestern University Feinberg School of Medicine. “This highlights the potential for developing strategies to alleviate food insecurity and its associated health conditions, as well as the use of food insecurity measures to refine individual CVD risk assessment.”

Inconsistent access to adequate food is thought to contribute to cardiometabolic diseases through restrictive and compensatory dietary behaviors, as well as stress, though the directional link remains unclear.2 Research indicates that individuals with both CVD and food insecurity are more likely to be women or Black and may face additional stressors, such as educational disparities, that could intensify this association.3

For this analysis, Jia and colleagues collected longitudinal data from CARDIA to evaluate the temporal association between food insecurity and CVD and establish the variation in the relationship by sex, education, or race. CARDIA recruited 5115 Black and White adults aged 18 to 30 years in 1985–1986, with the baseline for the current analysis marking the Year 15 examination (2000-2001) for 3616 individuals after applying exclusion criteria.1

Until 2020, participants completed an in-person examination every 5 years, with annual contact by telephone, mail, or electronic means. National Death Index searches were performed at approximately 5-year intervals. The primary outcome for the population was CVD events, comprised of fatal and nonfatal coronary heart disease, heart failure, stroke, transient ischemic attack, or peripheral arterial disease.

The total adult population in the analysis had a mean age of 40.1 years and 2027 (56%) were female. Approximately 1696 (47%) adult participants self-reported Black race and 529 (15%) experienced food insecurity at baseline. Those reporting food insecurity were more likely to be younger (mean age, 39.6 vs 40.2 years), self-report Black race (68% vs 43%), and report lower educational achievement (mean years of education, 13.5 years vs. 15.1 years).

Across the nearly 20-year follow-up period (mean, 18.8 years), 255 CVD events occurred, including 57 (11%) events in food-insecure participants and 198 (6%) in food-secure participants. Unadjusted CVD incidence rates were 6.0 events and 3.4 events per 1000 person-years in food-insecure and secure participants, respectively.

After a Cox proportional hazards model adjusted for age, sex, and field center, food insecurity was correlated with incident CVD (adjusted hazard ratio [aHR], 1.90; 95% CI, 1.41–2.56). Further adjustment for education, marital status, and usual source of medical care found food insecurity remained significantly associated with incident CVD (aHR, 1.47; 95% CI, 1.08–2.01).

Investigators noted that these findings align with existing longitudinal data on the link between food insecurity and CVD but emphasized the need for larger studies with diverse age groups and extended follow-up to fully assess CVD risk in this population.

“These prior studies, in conjunction with the current analysis, demonstrate that food insecurity is longitudinally associated with CVD risk factors, incident disease, and mortality, providing evidence that food insecurity is an important contributor to cardiovascular risk among US individuals,” Jia and colleagues wrote.

References

1. Jia J, Carnethon MR, Wong M, Lewis CE, Schreiner PJ, Kandula NR. Food Insecurity and Incident Cardiovascular Disease Among Black and White US Individuals, 2000-2020. JAMA Cardiol. Published online March 12, 2025. doi:10.1001/jamacardio.2025.0109

2. Chang R, Javed Z, Taha M, et al. Food insecurity and cardiovascular disease: Current trends and future directions. Am J Prev Cardiol. 2021;9:100303. Published 2021 Dec 10. doi:10.1016/j.ajpc.2021.100303

3. Brandt EJ, Chang T, Leung C, Ayanian JZ, Nallamothu BK. Food Insecurity Among Individuals With Cardiovascular Disease and Cardiometabolic Risk Factors Across Race and Ethnicity in 1999-2018. JAMA Cardiol. 2022;7(12):1218–1226. doi:10.1001/jamacardio.2022.3729