Associations of unhealthy food environment with the development of coronary artery calcification: The CARDIA Study

Background—While prior studies have linked the neighborhood environment and development of subclinical atherosclerosis, it is unknown whether living in neighborhoods with greater availability of “unhealthy” food outlets (fast-food chain restaurants and convenience stores) is associated with risk of developing coronary artery calcification (CAC). Methods and Results—We included 2706 CARDIA study (Coronary Artery Risk Development in Young Adults) participants who underwent CAC measurement during follow-up years 15 (2000–2001), 20 (2005–2006), and 25 (2010–2011). Neighborhood features examined included percentage of all food outlets that were convenience stores and fast-food chain restaurants within a 3- km Euclidean buffer distance from each participant’s residence. Econometric fixed effects models, which by design control for all time-invariant covariates, were used to model the longitudinal association between simultaneous within-person change in percentage food outlet and change in CAC. At baseline (year 15), 9.7% of participants had prevalent CAC. During 10 years of follow-up, 21.1% of participants developed CAC. Each 1-SD increase in percentage of convenience stores was associated with a 1.34 higher odds of developing CAC (95% CI: 1.04, 1.72) after adjusting for individual- and neighborhood-level covariates; however, there was no significant association between increased percentage of fast-food chain restaurants and developing CAC (odds ratio=1.15; 95% CI: 0.96, 1.38). There were no significant associations between increases in either food outlet percentage and progression of CAC. Conclusions—Our findings suggest that increases in the relative availability of convenience stores in participants’ neighborhoods is related to the development of CAC over time.