Higher consumption of ultraprocessed foods (UPFs) was significantly associated with an increased risk for ASCVD events, with a more pronounced association among Black Americans, based on findings from the Multiethnic Study of Atherosclerosis (MESA) being presented at ACC.26 in New Orleans and simultaneously published in JACC: Advances.

Researchers examined the longitudinal relationship between UPF consumption and ASCVD risk in 6,814 adults (45-84 years of age) enrolled in the MESA study who did not have clinically apparent cardiovascular disease. Using food questionnaires, each participant's daily intake of UPFs was assessed based on the NOVA classification system, which categorizes foods into four groupings ranging from unprocessed or minimally processed through ultraprocessed.

Participants in the highest quintile for UPF intake consumed 9.3 servings per day on average, while participants in the lowest quintile averaged 1.1 servings per day. Compared with the lowest quintile, participants in the highest quintile were 67% more likely to die from coronary heart disease or stroke or to experience a nonfatal heart attack, stroke or resuscitated cardiac arrest.

"We controlled for a lot of factors in this study," said Amier Haidar, MD, lead study author. "Regardless of the amount of calories you consumed per day, regardless of the overall quality of your diet, and after controlling for common risk factors like diabetes, high blood pressure, high cholesterol and obesity, the risk associated with higher UPF intake was still about the same."

Overall, each additional daily serving of UPFs was associated with a 5.1% increased risk of adverse cardiac events. However, this association was significantly amplified among Black Americans, who saw a 6.1% increase in risk with each additional serving compared with a 3.2% increase per serving among non-Black individuals. Researchers said that minority-targeted food marketing and neighborhood environmental factors that make it harder to access less-processed foods have likely contributed to inequities in UPF consumption and associated health impacts among different racial groups.

There were several limitations to the study. Since the MESA study was not designed specifically to collect data on UPF intake, researchers said that the dietary questionnaire data relied on self-reporting by participants and assessed processed food intake by number of servings rather than individual food items. The study also did not focus on the biological mechanisms involved.

Moving forward, Heidar said one way to reduce risk is to pay attention to the types of foods being consumed and to the food labels.

In a related editorial comment, Kim Allan Williams Sr., MD, MACC, says the "stronger UPF-ASCVD associations among Black Americans" highlights the urgency of structural solutions including the transparent front-of-packaging labels that provide "concise, biologically meaningful information at the point of purchase."'

A recent ACC Concise Clinical Guidance report authored by Williams et al., published in JACC highlights how front-of-package food labeling has been shown to increase consumer awareness and provides key considerations for implementing a transparent, science-based policy that prioritizes public health and offers clear direction to food manufacturers.

Keywords: ACC Annual Scientific Session, ACC26, Food Labeling, Diet, Food, and Nutrition, Risk, Food