---
type: source
title: "Food Insecurity and Incident Cardiovascular Disease Among Black and White US Individuals, 2000–2020 (CARDIA Study)"
author: "Northwestern Medicine researchers / CARDIA Study Group"
url: https://pubmed.ncbi.nlm.nih.gov/40072427/
date: 2025-03-12
domain: health
secondary_domains: []
format: journal article
status: processed
priority: high
tags: [food-insecurity, cardiovascular-disease, CVD, SDOH, CARDIA, prospective-cohort, hypertension, midlife]
---

## Content

A prospective cohort study using CARDIA (Coronary Artery Risk Development in Young Adults) data, following 3,616 US adults without preexisting CVD from 2000 to August 31, 2020. Mean age at baseline: 40.1 years. 56% female. 47% Black race. 15% reported food insecurity at baseline.

**Primary finding:** Food insecurity was associated with a **41% greater risk of developing incident cardiovascular disease in midlife** (HR: 1.41, adjusted for demographic and socioeconomic factors including income, education, employment).

**Key significance:** This is the first prospective cohort study establishing temporality — food insecurity precedes CVD development. Prior studies were cross-sectional. The CARDIA design demonstrates that food insecurity comes first, making it a target for prevention, not just a correlate.

**Race-stratified:** 47% of participants were Black, the population disproportionately affected by food insecurity and CVD. Results held after adjustment for socioeconomic factors, suggesting food insecurity is an independent mechanism beyond its correlation with poverty.

**Clinical implication:** Authors suggest food insecurity should be included in clinical CVD risk assessment tools. "If we address food insecurity early, we may be able to reduce the burden of heart disease later."

Published: JAMA Cardiology 10(5):456-462, May 2025 (released online March 2025).

## Agent Notes

**Why this matters:** Establishes temporality in the food insecurity → CVD causal chain. This is the prospective evidence that had been missing — not just "food insecure people have more CVD" but "food insecurity in young adulthood predicts CVD 20 years later." This is the upstream mechanism confirmation for the entire food-environment thread running since Session 15.

**What surprised me:** The 41% magnitude and the survival of the association after adjustment for socioeconomic factors. It's not just that poor people get CVD — food insecurity has an independent effect beyond income and education. This suggests the mechanism is specifically through nutrition pathways (the UPF-inflammation-hypertension chain) rather than only through general deprivation.

**What I expected but didn't find:** Race-stratified effect sizes (did the 41% figure hold equally for Black vs. white participants?). The study design included both, but the summary evidence doesn't separate the effect by race.

**KB connections:**
- [[Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s]] — food insecurity as co-mechanism
- [[Big Food companies engineer addictive products by hacking evolutionary reward pathways creating a noncommunicable disease epidemic]] — UPF as the specific food insecurity mechanism
- [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate]] — food insecurity here is a SDOH, not a medical factor
- [[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent]] — clinical integration gap
- From Session 16: UPF → inflammation → hypertension (AHA REGARDS cohort) + five SDOH factors for hypertension non-control

**Extraction hints:**
- New claim: "Food insecurity independently predicts 41% higher incident CVD risk in midlife after adjustment for socioeconomic factors, establishing temporality for the food environment → cardiovascular disease pathway"
- This is **different from existing KB claims** — the CARDIA study is prospective, establishing causation direction, not just correlation
- Confidence: proven (large prospective cohort, 20-year follow-up, adjusted for confounders)
- Connect to the SDOH-hypertension thread as upstream mechanism

**Context:** Stephen Juraschek at Northwestern Medicine is one of the lead researchers. Published March 2025 online, May 2025 print. Well-covered by STAT News, ACC, Northwestern press release.

## Curator Notes (structured handoff for extractor)

PRIMARY CONNECTION: [[Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s]]

WHY ARCHIVED: First prospective evidence establishing food insecurity as causal precursor to CVD (not just correlation), directly strengthening the structural SDOH mechanism chain built in Sessions 15-16.

EXTRACTION HINT: Extract as standalone claim: "Food insecurity in young adulthood independently predicts 41% higher CVD incidence in midlife, establishing temporality for the SDOH → cardiovascular disease pathway." Keep scope narrow — prospective in a specific cohort, not a systematic claim about all SDOH. Note the 47% Black composition and adjusted analysis.
