The risk rises steadily with greater intake. Each additional daily serving was linked to more than a 5% increase in the likelihood of heart attacks, strokes, or death from coronary heart disease or stroke. This relationship was even stronger among Black Americans compared with other racial groups.

“Ultra-processed foods are associated with an increased risk for heart disease, and while many of these products may seem like convenient on-the-go meal or snack options, our findings suggest they should be consumed in moderation,” said Amier Haidar, MD, a cardiology fellow at the University of Texas Health Science Center at Houston and the study’s lead author.

Large U.S. Study in a Diverse Population

This is one of the first large studies to examine the link between ultra-processed food intake and heart disease in a racially diverse group of U.S. adults. The results are consistent with earlier research, much of which has been conducted in Europe, and add important insight for a broader population.

The study analyzed data from 6,814 adults ages 45-84 years who did not have known heart disease and were part of the Multi-Ethnic Study of Atherosclerosis (MESA). Researchers used food questionnaires to estimate how many ultra-processed foods participants ate each day. They relied on the NOVA classification system, which sorts foods into four categories, ranging from unprocessed or minimally processed (e.g., corn on the cob) to ultra-processed (e.g., corn chips), with moderately processed foods in between (e.g., corn starch and canned corn).

Participants with the highest intake averaged 9.3 servings of ultra-processed foods per day, while those with the lowest intake averaged 1.1 servings. Compared with the lowest group, those in the highest group had a 67% greater risk of dying from coronary heart disease or stroke, or experiencing non-fatal heart attacks, strokes or resuscitated cardiac arrest.

Risk Persists Beyond Calories and Diet Quality

“We controlled for a lot of factors in this study,” Haidar said. “Regardless of the amount of calories you consumed per day, regardless of the overall quality of your diet, and after controlling for common risk factors like diabetes, high blood pressure, high cholesterol and obesity, the risk associated with higher ultra-processed food intake was still about the same.”

These findings suggest that the harmful effects of ultra-processed foods may not be explained by calories or overall diet quality alone. The way foods are processed could play an independent role in cardiovascular risk, making it important to consider both processing and nutrient content.

Disparities in Risk and Contributing Factors

Each additional daily serving of ultra-processed foods was associated with a 5.1% increase in the risk of adverse cardiac events. This increase was greater among Black Americans, who experienced a 6.1% rise in risk per serving compared with 3.2% among non-Black individuals. Researchers noted that factors such as targeted marketing and limited access to less-processed foods in some neighborhoods may contribute to differences in consumption and health outcomes.

Study Limitations and Possible Biological Effects

The study has several limitations. Because the MESA study was not originally designed to specifically measure ultra-processed food intake, the data relied on self-reported dietary questionnaires. Intake was measured by servings rather than tracking individual foods.

The researchers did not directly investigate the biological mechanisms involved. However, earlier studies suggest that ultra-processed foods tend to be high in calories, added sugars and fats, and may affect hunger and metabolism. These factors can lead to weight gain, inflammation and the buildup of visceral fat, all of which increase the risk of heart disease.

How to Lower Risk Through Better Food Choices

Haidar said one way to reduce risk is to be more aware of the types of foods you eat and to read nutrition labels carefully. Labels provide details on added sugar, salt, fat and carbohydrates per serving, which are often higher in ultra-processed foods than in less-processed options like plain oatmeal, nuts, beans and fresh or frozen produce.

The ACC published a 2025 Concise Clinical Guidance report in JACC endorsing a standardized front-of-package labeling system to help make sure that healthier choices are more visible, accessible and achievable for all consumers.

This study was published simultaneously in JACC Advances.

The study found that higher levels of visceral fat were more closely tied to heart failure risk than overall body weight. Larger waist measurements were linked to increased risk even in people whose body mass index (BMI) fell within a normal range. These results suggest that where fat is stored in the body may be more important than how much a person weighs. Inflammation appears to help explain why belly fat has such a strong impact on heart health. Measuring waist size may therefore provide a better way to identify people at higher risk than relying on BMI alone.

“This research helps us understand why some people develop heart failure despite having a body weight that seems healthy,” said Szu-Han Chen, lead author of the study and a medical student at National Yang Ming Chiao Tung University in Taiwan. “By monitoring waist size and inflammation, clinicians may be able to identify people with higher risk earlier and focus on prevention strategies that could reduce the chance of heart failure before symptoms begin.”

The Role of Inflammation in Heart Disease

A 2025 scientific statement from the American Heart Association on risk-based primary prevention of heart failure highlights systemic inflammation, or inflammation throughout the body, as a major contributor to heart disease. It can disrupt immune function, damage blood vessels, and promote the buildup of scar tissue in the heart. The Association has also reported that higher inflammation levels are linked to increased heart disease risk, even in people with normal cholesterol levels.

Key Findings From the Study

The researchers reported several important observations:

• 112 participants developed heart failure over a median follow-up period of 6.9 years
• Higher levels of excess fat around the waist were associated with increased heart failure risk, while higher BMI was not
• Both waist circumference and waist-to-height ratio were linked to greater risk
• Participants with higher inflammation levels, measured through blood tests, were more likely to develop heart failure over nearly seven years
• Inflammation accounted for about one-quarter to one-third of the connection between abdominal fat and heart failure risk

Implications for Prevention and Screening

“This study highlights the importance of integrating measures of central adiposity such as waist circumference into routine preventive care. Understanding upstream drivers of heart failure risk including central adiposity is key to recognizing and modifying risk,” said Sadiya S. Khan, M.D., M.Sc., FAHA, volunteer chair of the American Heart Association’s 2025 Scientific Statement: Risk-Based Primary Prevention of Heart Failure. “This study builds on prior research that highlights the importance of excess or dysfunctional adiposity in the development of heart failure, which informed the inclusion of body mass index into the PREVENT-HF risk equations to estimate risk of heart failure. However, future research should identify if central adiposity has greater predictive utility beyond strength of association.” Khan, who was not involved in the study, is also Magerstadt Professor of Cardiovascular Epidemiology and an associate professor of cardiology and preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

Study Limitations and Next Steps

The researchers noted that they did not have detailed data on different types of heart failure, so the findings apply to heart failure overall. Future studies are needed to explore how visceral fat and inflammation affect specific subtypes of heart failure and whether reducing inflammation could help lower risk.

Study Design and Participant Details

The analysis included health data from 1,998 African American adults living in both urban and rural areas of Jackson, Mississippi, who participated in the Jackson Heart Study. None of the participants had heart failure when they enrolled between 2000 and 2004.

Participants ranged in age from 35 to 84, with an average age of 58, and 36 percent were women. They were followed for a median of 6.9 years, through December 31, 2016.

Researchers evaluated body fat using several measures, including weight, body mass index (BMI), waist circumference, and waist-to-height ratio. Blood samples were also analyzed for high-sensitivity C-reactive protein, a widely used marker of inflammation.

The study was conducted under the guidance of Professor Hao-Min Cheng at Taipei Veterans General Hospital and National Yang Ming Chiao Tung University.