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&rsquo;s ability to make healthy dietary choices and increase their risk of&nbsp;<br />developing CVD through multiple pathways.<br />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&nbsp;<br />disease, myocardial infarction, stroke, heart failure, peripheral artery disease, and CVD-related mortality.&nbsp;<br />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&nbsp;<br />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.&nbsp;<br />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&nbsp;<br />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. &nbsp;<br />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&nbsp;<br />certainty of evidence for other outcomes. &nbsp;