Lloyd, M., Amos, M. E., Milfred-Laforest, S., Motairek, I. K., Pascuzzi, K., Petermann-Rocha, F., Elgudin, Y., Nasir, K., Freedman, D., Al-Kindi, S., Pell, J., & Deo, S. V. (2023). Residing in a food desert and adverse cardiovascular events in US veterans with established cardiovascular disease. The American Journal of Cardiology, 196, 70–76. https://doi.org10.1016/j.amjcard.2023.03.010

https://doi.org/10.1016/j.amjcard.2023.03.010

Veterans
Physical health

Multiple branches

Veteran

Veteran

Adulthood (18 yrs & older)
Middle age (40 - 64 yrs)
Aged (65 yrs & older)

Quantitative Study

Lloyd, Mackenzie, Amos, Mary Ellen, Milfred-Laforest, Sherry, Motairek, Issam Kamel, Pascuzzi, Kristina, Petermann-Rocha, Fanny, Elgudin, Yakov, Nasir, Khurram, Freedman, Darcy, Al-Kindi, Sadeer, Pell, Jill, Deo, Salil Vasudeo

Residents living in a “food desert” are known to be at a higher risk for developing cardiovascular disease (CVD). However, national-level data regarding the influence of residing in a food desert in patients with established CVD is lacking. Data from veterans with established atherosclerotic CVD who received outpatient care in the Veterans Health Administration system between January 2016 and December 2021 were obtained, with follow-up information collected until May 2022 (median follow-up: 4.3 years). A food desert was defined using the United States Department of Agriculture criteria, and census tract data were used to identify Veterans in these areas. All-cause mortality and the occurrence of major adverse cardiovascular events (MACEs; a composite of myocardial infarction/stroke/heart failure/all-cause mortality) were evaluated as the co-primary end points. The relative risk for MACE in food desert areas was evaluated by fitting multivariable Cox models adjusted for age, gender, race, ethnicity, and median household income, with food desert status as the primary exposure. Of the 1,640,346 patients (mean age 72 years, women 2.7%, White 77.7%, Hispanic 3.4%), 25,7814 (15.7%) belonged to the food desert group. Patients residing in food deserts were younger; more likely to be Black (22% vs 13%)or Hispanic (4% vs 3.5%); and had a higher prevalence of diabetes mellitus (52.7% vs 49.8%), chronic kidney disease (31.8% vs 30.4%,) and heart failure (25.6% vs 23.8%). Adjusted for covariates, food desert patients had a higher risk of MACE (hazard ratio 1.040 [1.033 to 1.047]; p <0.001) and all-cause mortality (hazard ratio 1.032 [1.024 to 1.039]; p <0.001). In conclusion, we observed that a large proportion of US veterans with established atherosclerotic CVD reside in food desert census tracts. Adjusting for age, gender, race, and ethnicity, residing in food deserts was associated with a higher risk of adverse cardiac events and all-cause mortality.

Elsevier

Article

Department of Pharmacy, Louis Stokes Cleveland VA Medical Center, ML
Department of Pharmacy, Louis Stokes Cleveland VA Medical Center, MEA
Department of Pharmacy, Louis Stokes Cleveland VA Medical Center, SML
Department of Pharmacy, Louis Stokes Cleveland VA Medical Center, KP
Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, IKM
Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, SA
Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, FPR
School of Health and Wellbeing, University of Glasgow, FPR
School of Health and Wellbeing, University of Glasgow, JP
School of Health and Wellbeing, University of Glasgow, SVD
Division of Cardiothoracic Surgery, Louis Stokes Cleveland VA Medical Center, YE
Division of Cardiothoracic Surgery, Louis Stokes Cleveland VA Medical Center, SVD
Case School of Medicine, Case Western Reserve University, YE
Case School of Medicine, Case Western Reserve University, SVD
Department of Population Health and Quantitative Sciences, Case School of Medicine, Case Western Reserve University, DF
Department of Population Health and Quantitative Sciences, Case School of Medicine, Case Western Reserve University, SVD
Department of Medicine, Houston Methodist Hospital, KN