---
type: claim
domain: health
description: First prospective cohort evidence showing food insecurity precedes CVD development by 20 years, proving causal direction rather than mere correlation
confidence: proven
source: CARDIA Study Group / Northwestern Medicine, JAMA Cardiology 2025, 3,616 participants followed 2000-2020
created: 2026-04-01
attribution:
  extractor:
    - handle: "vida"
  sourcer:
    - handle: "northwestern-medicine-/-cardia-study-group"
      context: "CARDIA Study Group / Northwestern Medicine, JAMA Cardiology 2025, 3,616 participants followed 2000-2020"
supports:
- food-as-medicine-interventions-produce-clinically-significant-improvements-during-active-delivery-but-benefits-fully-revert-when-structural-food-environment-support-is-removed
- Food insecurity creates a bidirectional reinforcing loop with cardiovascular disease where disease drives dietary insufficiency through medical costs and dietary insufficiency drives disease through ultra-processed food reliance
reweave_edges:
- food-as-medicine-interventions-produce-clinically-significant-improvements-during-active-delivery-but-benefits-fully-revert-when-structural-food-environment-support-is-removed|supports|2026-04-03
- Food insecurity creates a bidirectional reinforcing loop with cardiovascular disease where disease drives dietary insufficiency through medical costs and dietary insufficiency drives disease through ultra-processed food reliance|supports|2026-04-07
---

# Food insecurity in young adulthood independently predicts 41% higher CVD incidence in midlife after adjustment for socioeconomic factors, establishing temporality for the SDOH → cardiovascular disease pathway

The CARDIA prospective cohort study followed 3,616 US adults without preexisting CVD from 2000 to 2020 (mean baseline age 40.1 years, 56% female, 47% Black). Food insecurity at baseline was associated with HR 1.41 for incident CVD after adjustment for income, education, and employment. This is the first prospective study establishing temporality—food insecurity comes first, CVD follows 20 years later. Prior studies were cross-sectional and could not distinguish whether food insecurity caused CVD or whether CVD-related disability caused food insecurity. The persistence of the association after socioeconomic adjustment suggests food insecurity operates through specific nutritional pathways (likely the UPF-inflammation-hypertension chain documented in Session 16) rather than only through general poverty effects. The 47% Black composition addresses the population most affected by both food insecurity and CVD disparities. Authors recommend integrating food insecurity screening into clinical CVD risk assessment, stating 'If we address food insecurity early, we may be able to reduce the burden of heart disease later.' This provides the upstream causal evidence that the entire food-environment thread has been building toward.

---

### Additional Evidence (extend)
*Source: [[2025-11-10-statnews-aha-food-is-medicine-bp-reverts-to-baseline-juraschek]] | Added: 2026-04-01*

AHA 2025 RCT showed that eliminating food insecurity through DASH grocery delivery + dietitian support produced significant BP and LDL improvements during 12-week intervention, but both reverted completely to baseline 6 months after program ended. This extends the observational food insecurity → CVD pathway with experimental evidence showing the mechanism is reversible during active intervention but requires continuous structural support.


Relevant Notes:
- [[Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s]]
- [[Big Food companies engineer addictive products by hacking evolutionary reward pathways creating a noncommunicable disease epidemic more deadly than the famines specialization eliminated]]
- medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate
- [[five-adverse-sdoh-independently-predict-hypertension-risk-food-insecurity-unemployment-poverty-low-education-inadequate-insurance]]
- [[hypertension-related-cvd-mortality-doubled-2000-2023-despite-available-treatment-indicating-behavioral-sdoh-failure]]

Topics:
- [[_map]]