Adults who eat the most ultra-processed food face a substantially higher risk of heart attack, stroke and related cardiac events than those who eat the least, according to an analysis of a long-running U.S. heart study published this year in the journal JACC: Advances. The study, led by Dr. Amier Haidar, a cardiology fellow at the University of Texas Health Science Center at Houston, was also presented at the American College of Cardiology's annual scientific session.
Researchers tracked 6,814 adults ages 45 to 84 enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA), a long-term cohort with no heart disease at enrollment. Participants were grouped by how much ultra-processed food they reported eating, using the NOVA classification system, which sorts foods from unprocessed or minimally processed up to heavily industrialized products such as packaged snacks, sugary drinks, frozen meals and processed meats. Those in the highest intake group averaged 9.3 servings of ultra-processed food a day, compared with 1.1 servings in the lowest group. Over the follow-up period, the highest-intake group had a 67% higher risk of a major cardiac event — including heart attack, stroke or death from coronary disease — than the lowest-intake group. Each additional daily serving was associated with roughly a 5% rise in risk.
A disparity by race
The association was notably stronger among Black participants: each additional daily serving of ultra-processed food was linked to about a 6% increase in cardiac risk in that group, compared with roughly 3% among non-Black participants, according to the American College of Cardiology's summary of the findings. The authors did not identify a single clear explanation for the gap, though they noted that structural factors such as food access and neighborhood environment likely play a role.
The findings add to a growing body of research tying ultra-processed foods to cardiovascular harm, including a separate analysis presented at the same ACC meeting that linked high ultra-processed intake to a sharply elevated risk of major cardiac events in a different population. It is important to note that this MESA analysis, like most nutrition research of its kind, is observational: it can show an association between diet patterns and later cardiac events, but it cannot prove that ultra-processed food itself directly causes heart attacks or strokes, since people who eat more of it often differ from those who don't in other ways, such as overall diet quality, exercise and income.
"Ultra-processed foods may contribute to cardiovascular risk through mechanisms beyond excess calories or poor overall diet quality," Haidar said, pointing to food additives, industrial processing methods and the displacement of fiber-rich whole foods as possible contributing factors that aren't yet fully understood.
The researchers say the next step is to test whether reducing ultra-processed food intake directly lowers cardiac risk in controlled trials, rather than relying solely on observational data. In the meantime, the American College of Cardiology is using the findings to encourage clinicians to ask patients more specifically about processed-food intake, not just broad diet quality, during routine cardiovascular risk counseling.
