Food desert fears: American Heart Association to spotlight dangers of nutrition insecurity

01 Nov 2022 --- A new study has revealed that people living in “food deserts” – areas and communities that have minimal to no access to nutritious foods – may have an increased risk of stroke, heart attack and premature death if they suffer from a narrowing of arteries that carry blood away from the heart known as peripheral artery disease (PAD). 

The findings will be presented at the American Heart Association’s (AHA) Scientific Session 2022 in Chicago, Illinois, US (Nov 5-7).

“While guideline-directed care for PAD reduces complications, the influence of social determinants of health, like living in a food desert, on receiving optimal care has not been previously explored,” says Dr. Rayan S. El-Zein, lead study author and a researcher at Saint Luke’s Mid America Heart Institute at the University of Missouri-Kansas City, US.

“Our results underscore the importance of screening for social and environmental barriers among people with PAD, particularly those who live in under-resourced communities,” El-Zein explains. “The scope of PAD treatment to lower cardiovascular risk and improve PAD-related health must reach beyond clinic visits, prescriptions and procedures.”

The study reveals that PAD patients in food deserts have increased risks of a major cardiac event.Focus on the peripherals
PAD usually occurs in the leg but can occur anywhere in the body. The reduced blood flow caused by arterial constriction can cause severe health problems and even death. The AHA has issued guidelines for the treatment of PAD that include smoking cessation and structured exercise therapy. 

It also recommends customized medication combinations to address individual risk factors like high blood pressure, high cholesterol, stroke, Type 2 diabetes or amputations. The organization also promotes treatment through diets high in vegetables, legumes, fruits and whole grains. Low-fat dairy products, nuts and seeds, poultry and fish. 

Furthermore, the AHA promotes the use of olive oil over “tropical oils” and states that PAD patients should limit their intake of sugar, red meat, trans fats and sodium. However, those living in food deserts may be unable to adhere to such dietary standards.

“Living in food deserts is associated with worse overall health and an increased risk of death among people with PAD, as well as a lower likelihood of receiving evidence-based treatments that can lower risk,” El-Zein stresses. “Healthcare providers should absolutely ask patients with PAD about their access to healthy foods and about their ability to afford and access medical care.” 

“This is essential to holistic and meaningful patient engagement in chronic disease.”

A discriminatory disease?
The study also found that, compared to participants with healthy food access, those diagnosed with PAD and living in food desert areas were more likely to live in an urban zone, have Type 2 diabetes, have high blood pressure, not own a car and be Hispanic or Black. These same factors are associated with an inability to receive proper or optimal care for these illnesses.

It also found that there were many factors associated with ineffective medical treatment regardless of food availability. Women have a 19% lower chance of receiving optimal medical treatment, those with chronic obstructive pulmonary disease have a 36% lower chance, those with kidney disease have a 19% lower chance and those in low-income areas have an 11% lower chance. 

Additionally, the study stressed that, though calf pain is a common symptom of PAD in men, women often report pain in other parts of the leg or do not feel any pain at all. The differences in symptoms also means that their diagnoses are often delayed because they are mistaken for other diseases like osteoarthritis.Symptoms differ between men and women, which often impedes women’s diagnoses.

“There may be multiple reasons for this,” says El-Zein. “Women’s symptoms are less commonly recognized as PAD-related, and their diagnosis is often delayed.”

Need for education
The study incorporated the data of 11,907 patients treated for PAD in the Saint Luke Health System from 2015 to 2021 in its analyses and was funded by Saint Luke’s Mid-America Heart Institute. Of the patients included, 15.4% reported living in food deserts. 

The researchers compared the outcomes of those living in food deserts to those in proximity to affordable, nutritious and healthy foods. They further found that people experiencing food insecurity were 17% more likely to experience strokes, heart attacks and death than those with access to healthy foods.

“Recognizing that social determinants of health, including access to healthy foods, influence outcomes in people with PAD is extremely important,” concludes Dr. Mark Creager, director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, US, and former president of the AHA. 

“It helps inform communities, policymakers and governmental agencies about disparities that must be addressed to improve the health of our population.”

Edited by William Bradford Nichols