News & Perspective

The CARDIA study – Association of unhealthy food environment with the development of coronary artery calcification

1 year ago, OP Editor

Studies have shown a link between neighborhood socioeconomic deprivation and the development of subclinical atherosclerosis.1 One study associated neighborhood deprivation and low social cohesion with symptomatic coronary artery calcification (CAC) in young adults, and in a separate study, a 20-year exposure to neighborhood poverty was found to be associated with a greater cardiovascular risk for women.2,3

Many cardiovascular disease prevention guidelines including those from the World Health Organization and the European Society of Cardiology specify the importance of a healthy diet, such as to reduce saturated and trans-fat intake, as well as reduced consumption of salt and alcohol.4,5 Residents in neighborhoods with a high availability of convenience stores was strongly associated to diet-related adverse cardiometabolic health outcomes compared to those living in neighborhoods with less convenience stores.6 On the other hand, a greater access to healthy food resources within a neighborhood was found to be suggestive to slow the development of coronary atherosclerosis in middle-aged and older adults.7 Despite these results, further studies investigating the impact of easier access to stores selling unhealthy food and other substances on the development of CAC were necessary for gathering additional data and understanding the potential factors that can influence the risk of cardiovascular disease.1

The Coronary Artery Risk Development in Young Adults (CARDIA) study is a prospective, multicenter and cohort study which began in 1985 to examine the development and determinants of clinical and subclinical cardiovascular disease and their risk factors.1,8 A total of 5,115 black and white men and women aged between 18 to 30 years were entered into the study and follow-up examinations were carried out in subsequent years, mostly to collect data on factors believed to be related to heart disease such as hypertension, cholesterol and glucose measurements.8 A recent investigation was carried out on 2,706 of the CARDIA participants to assess the impact of fast-food chain restaurants and convenience stores on the development of CAC, independent of neighborhood poverty.1 The inclusion criteria for this analysis were patients who had a CAC scan at baseline and at either or both of the 5- and 10-year follow-up examinations, with no history of cardiovascular disease.1 The residential addresses of the participants with data on food resources at the time of each examination were collected, and a percentage of these unhealthy food outlets within a 3km radius were calculated to provide a measure of the prevalence of these outlets within the neighborhood.1 This study was carried out over a ten-year period, with measurements of CAC at examination years 15, 20 and 25 (of the CARDIA study) using computed tomography (CT) scanning.1

The results showed that more men than women developed CAC, with a higher risk in smokers and those with hypertension, hypercholesterolemia and diabetes, than those without these risk factors.1 Though the mean percentage of fast-food chain restaurants per neighborhood did not differ between those who developed and those who did not develop CAC, a larger mean percentage of neighborhood convenience stores were found amongst participants who developed CAC, at 16.4% compared to 15.8% in those who did not develop CAC.1

The study concluded that the increased percentage of convenience stores in the neighborhood was related to the increase in the development of CAC, with previous research also showing that the less nutritious food choices are usually more widely advertised, and with certain placements within stores for extensive selection.1 However, the consumption of unhealthy non-food items from convenience stores may also have an impact, such as cigarettes and alcohol.1 These new evidences support the idea that living environment can also impact a person’s cardiovascular health.1


  1. Kelman J, Pool L, Gordon-Larsen P, et al. Associations of Unhealthy Food Environment With the Development of Coronary Artery Calcification: The CARDIA study. J Am Heart Assoc. 2019;8:e010586.
  2. Murray E, Diez Roux A, Carnethon M, et al. Trajectories of Neighborhood Poverty and Associations With Subclinical Atherosclerosis and Associate Risk Factors. Am J Epidemiol. 2010;171(10):1099-108.
  3. Kim D, Diez Rouz A, Kiefe C, et al. Do neighborhood socioeconomic deprivation and low social cohesion predict coronary calcification?: the CARDIA study. Am J Epidemiol. 2010;172(3):288-98.
  4. World Health Organization. Prevention of Cardiovascular Disease. Guidelines for assessment and management of cardiovascular risk. 2007. (Accessed March 13, 2019, at;jsessionid=927
  5. Piepoli M, Hoes A, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315-81.
  6. Rummo P, Meyer K, Boone-Heinonen J, et al. Neighborhood availability of convenience stores and diet quality: findings from 20 years follow-up in the coronary artery risk development in young adults study. Am J Public Health. 2015;105(5):e65-73.
  7. Wing J, August E, Adar S, et al. Change in Neighborhood Characteristics and change in Coronary Artery Calcium: A Longitudinal Investigation in the MESA (Multi-Ethnic Study of Atherosclerosis) Cohort. Circulation. 2016;134(7):504-13.
  8. The Coronary Artery Risk Development in Young Adults Study (CARDIA). (Accessed March 12, 2019, at


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