Association Between Living in Food Deserts and Cardiovascular Risk

• Type of Material: Article
• Authors: Heval M. Kelli, Emory University; Muhammad Hammadah, Emory University; Hina Ahmed, Emory University; Yi-An Ko, Emory University; Matthew Topel, Emory University; Ayman Samman-Tahhan, Emory University; Mossab Awad, Emory University; Keyur Patel, Emory University; Kareem Mohammed, Emory University; Laurence S Sperling, Emory University; Priscilla Pemu, Morehouse School of Medicine; Viola Vaccarino, Emory University; Tene T. Lewis, Emory University; Herman A. Taylor, Emory University; Greg Martin, Emory University; Gary H. Gibbons, National Heart, Lung, and Blood Institute; Arshed Ali Quyyumi, Emory University
• Language: English
• Date: 2017-09-01
• Publisher: American Heart Association
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 American Heart Association, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1161/CIRCOUTCOMES.116.003532
• Title of Journal or Parent Work: Circulation: Cardiovascular Quality and Outcomes
• ISSN: 1941-7705
• Volume: 10
• Issue: 9
• Start Page: e003532
• End Page: e003532
• Grant/Funding Information: H.M.K has been supported by the Abraham J. and Phyllis Katz Foundation and NHLBI T32 THL130025A.; Additional support comes from NIH grants 5P20HL113451, 5P01HL101398, 1R56HL126558, 1U10HL110302, U01HL079156, R01HL109413, R01HL125246, and K24HL077506.; The META-Health study was supported by funding from National Institutes of Health/National Heart, Blood, and Lung Institute (NIH/NHLBI) 1 U01 HL079156-01 (Quyyumi) and 1 U01 HL79214-01 (Gibbons); NIH, National Center for Research Resources (NCRR) Grant M01-RR00039 for the Emory General Clinical Research Center (GCRC); NIH/NCRR 5P20RR11104 for the Morehouse CRC.; The CHDWB study was supported by the Marcus and Woodruff Foundations, Atlanta, Georgia; and the Emory University/Georgia Tech Predictive Health Institute and award UL1 RR025008 and UL1 TR000454 from the Clinical and Translational Science Award Program, National Institutes of Health, National Center for Research Resources and National Center for Advancing Translational Sciences.
• Keywords: ARTERIAL STIFFNESS; JOINT-NATIONAL-COMMITTEE; HIGH BLOOD-PRESSURE; DISEASE MORTALITY; risk factors; Cardiac & Cardiovascular Systems; HEART-DISEASE; prevalence; epidemiology; coronary disease; OXIDATIVE STRESS; hypertension; Life Sciences & Biomedicine; UNITED-STATES; Science & Technology; SOCIOECONOMIC-STATUS; C-REACTIVE PROTEIN; Cardiovascular System & Cardiology; VASCULAR DYSFUNCTION
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background-Food deserts (FD), neighborhoods defined as low-income areas with low access to healthy food, are a public health concern. We evaluated the impact of living in FD on cardiovascular risk factors and subclinical cardiovascular disease (CVD) with the hypothesis that people living in FD will have an unfavorable CVD risk profile. We further assessed whether the impact of FD on these measures is driven by area income, individual household income, or area access to healthy food. Methods and Results-We studied 1421 subjects residing in the Atlanta metropolitan area who participated in the METAHealth study (Morehouse and Emory Team up to Eliminate Health Disparities; n=712) and the Predictive Health study (n=709). Participants' zip codes were entered into the United States Food Access Research Atlas for FD status. Demographic data, metabolic profiles, hs-CRP (high-sensitivity C-reactive protein) levels, oxidative stress markers (glutathione and cystine), and arterial stiffness were evaluated. Mean age was 49.4 years, 38.5% male and 36.6% black. Compared with those not living in FD, subjects living in FD (n=187, 13.2%) had a higher prevalence of hypertension and smoking, higher body mass index, fasting glucose, and 10-year risk for CVD. They also had higher hs-CRP (P=0.014), higher central augmentation index (P=0.015), and lower glutathione level (P=0.003), indicative of increased oxidative stress. Area income and individual income, rather than food access, were associated with CVD risk measures. In a multivariate analysis that included food access, area income and individual income, both low-income area and low individual household income, were independent predictors of a higher 10-year risk for CVD. Only low individual income was an independent predictor of higher hs-CRP and augmentation index. Conclusions-Although living in FD is associated with a higher burden of cardiovascular risk factors and preclinical indices of CVD, these associations are mainly driven by area income and individual income rather than access to healthy food.