The Association of Food Insecurity with Cardiovascular Disease: A Systematic Review

Importance: Cardiovascular diseases (CVD) are the leading cause of death in the United States. Food insecurity may limit one’s ability to make healthy dietary choices and increase their risk of  developing CVD through multiple pathways. Objective: This systematic review aims to determine the impact of experiencing food insecurity on the incidence and prevalence of cardiovascular disease outcomes, including coronary heart  disease, myocardial infarction, stroke, heart failure, peripheral artery disease, and CVD-related mortality.  Methods: PubMed database was searched from January 2016 to May 2026 to identify studies examining the impact of food insecurity on cardiovascular disease outcomes. Study  characteristics and reported cardiovascular outcomes were abstracted and summarized. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the NOS-xs adaptation for cross-sectional studies.  Results: Out of 132 studies screened (128 from database searching, 4 from backward searching and handsearching), 9 met eligibility criteria (four cross-sectional and five longitudinal). Low  strength of evidence was available to relate food insecurity to CVD mortality. Food insecurity was associated with other CVD outcomes with very low certainty of evidence.   Conclusions: At the time of this review, there is moderate strength evidence to suggest that experiencing food insecurity is associated with increased CVD mortality. However, there is less  certainty of evidence for other outcomes.