Association between ultraprocessed food consumption and cardiovascular disease risk: MESA (Multiethnic Study of Atherosclerosis)

Authors: HAIDAR, AMIER - University Of California (UCLA); RIKHI, RISHI - Wake Forest University School Of Medicine; WATSON, KAROL - University Of California (UCLA); WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC); SHAPIRO, MICHAEL - University Of California (UCLA)

Submitted to: JACC: Advances
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/18/2025
Publication Date: 3/17/2026
Citation: Haidar, A., Rikhi, R., Watson, K.E., Wood, A.C., Shapiro, M.D. 2026. Association between ultraprocessed food consumption and cardiovascular disease risk: MESA (Multiethnic Study of Atherosclerosis). JACC: Advances. https://doi.org/10.1016/j.jacadv.2025.102516.
DOI: https://doi.org/10.1016/j.jacadv.2025.102516

Interpretive Summary: Cardiovascular disease is a leading cause of death, and diet plays a major role in shaping risk, especially as more than half of calories in the U.S. now come from ultraprocessed foods. This study examined whether eating more ultraprocessed foods—such as packaged snacks, sugary drinks, and ready-to-eat meals—raises the risk of heart disease in a diverse group of over 6,800 U.S. adults. Researchers followed participants for many years and found that each additional daily serving of ultraprocessed food increased the risk of cardiovascular disease, with those eating the most having about 67% higher risk than those eating the least. Importantly, the harmful effects were even stronger among Black participants, highlighting potential health disparities. These findings suggest that ultraprocessed foods may contribute to heart disease through pathways such as inflammation, poor diet quality, and metabolic dysfunction. This research is important for clinicians, policymakers, and the public because it supports efforts to reduce ultraprocessed food consumption and improve access to healthier foods, especially in communities most affected by diet-related disease.

Technical Abstract: Ultraprocessed foods (UPFs) have been linked to adverse cardiometabolic outcomes and increased atherosclerotic cardiovascular disease (CVD) (ASCVD) risk. However, prior research has largely focused on homogenous populations, lacking racial and ethnic diversity. The objectives are to examine the longitudinal relationship between UPF consumption and ASCVD risk and to investigate whether these associations differ by race/ethnicity, sex, or socioeconomic status. The MESA (Multiethnic Study of Atherosclerosis) is a prospective cohort study of 6,814 U.S. adults aged 45 to 84 years, without clinically apparent CVD. UPF consumption was classified according to the Nova classification system. Multivariable cox proportional hazards models were used to evaluate the association between UPF intake and incident CVD events. Incident CVD events included nonfatal myocardial infarction, resuscitated cardiac arrest, death resulting from coronary heart disease, stroke (not transient ischemic attack), and death resulting from stroke. Each additional daily serving of UPF was associated with a 5.1% increased risk of ASCVD events (HR: 1.051; 95% CI: 1.011-1.093). Participants in the highest quintile of UPF consumption had a 66.8% higher risk compared to those in the lowest (HR: 1.668; 95% CI: 1.196-2.325). A significant multiplicative interaction was observed between UPF intake and Black race (P=0.010), with stratified analyses demonstrating a higher ASCVD risk in Black Americans (HR: 1.061; 95% CI: 1.016-1.108), compared to non-Black Americans (HR: 1.032; 95% CI: 1.001-1.065). In a large, multiethnic cohort, higher UPF consumption was significantly associated with an increased risk for ASCVD events, with a more pronounced association among Black Americans.