Living Near Bars, Restaurants Linked to Greater Likelihood of HF

Living in close proximity to bars, restaurants, and fast-food outlets could influence the risk of developing heart failure (HF), data from the UK Biobank suggest.

According to senior author Lu Qi, MD, PhD (Tulane University, New Orleans, LA), the study is one of the first to suggest a direct link between HF risk and food environment, rather than the type or quality of foods people consume.

In the study, the risk was shown to be highest for people living in areas where there was a dense concentration of prepared food options, with a strong correlation between how close people lived to the establishments serving these foods and their risk of HF. There also was a correlation between HF risk and not having a college degree, as well as living in areas without access to gyms and other facilities for physical fitness.

To TCTMD, Qi said the study cannot determine whether the HF risk is driven by the proximity to a ready-to-eat environment itself or by other factors such as food insecurity that make those places the better choice economically or more accessible than supermarkets with fresh food.

However, he added that “future studies, especially intervention trials, may test whether education to encourage eating at home, rather than at ready-to-eat outlets, may lower risk.”

In their accompanying editorial, Elissa Driggin, MD, and Ersilia M. DeFilippis, MD (both NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY), note that “food-as-medicine programs, where healthy groceries are provided to patients in conjunction with health coaching, patient education, and dietitian consultations, have been used in patients with diabetes and hypertension and have the opportunity to reach patients with heart failure.”

Qi added that clinicians likely provide knowledge on diet and healthy foods when addressing nutrition with their patients, but don’t necessarily explore eating behaviors.

“Food as medicine would cover a broad range of improvement related to foods and eating behaviors,” he noted.

Where You Live Matters

For the study, Qi and colleagues led by Qiaochu Xue, MPH (Tulane University) used data from UK Biobank entries on 478,598 individuals (mean age 56.5 years; 55% women) with self-reported lifestyle information and medical history, as well as hospital in-patient records.

The average number of ready-to-eat food outlets within less than a mile of where participants lived was 3.5, with an average distance to pubs and bars of 0.43 miles, to restaurants and cafeterias of 0.5 miles, and to fast-food outlets or hot and cold takeaway of 0.70 miles.

Over a median follow-up of 12 years, there were 12,956 incident cases of HF. Individuals living less than 500 meters (0.31 miles) from pubs and bars had a 13% increased risk of HF (P = 0.0007), with a 10% increased risk if they were within that distance to fast-food outlets (P = 0.0017) compared with those who lived 2,000 meters (1.2 miles) or more from any of those places.

Those living in neighborhoods with three or more pubs or bars had a 14% increased risk compared with those in areas with none (P < 0.0001) and those living in neighborhoods with three or more fast-food restaurants had a 12% increased risk compared with those living where there were none (P < 0.00001).

In subgroup analyses, the findings did not differ by sex, but HF risk was greater in those with no college degree (P for interaction = 0.0183) and those living where few physical activity facilities were located (P for interaction = 0.0038).

Qi and colleagues note that the study adds to accumulating evidence that where people live can influence their CV health, including research from the Netherlands that showed a higher incidence of HF among individuals residing within approximately half a mile of fast-food outlets.

An important limitation of the study that impacts its generalizability is that 94% of patients were white Europeans, Driggin and DeFilippis say. “Given the clear association between Black race and a high incidence of HF as compared with white patients, as well as associations with worse HF outcomes, attention to food environment in this high-risk population is of the utmost importance.”

They add that more detailed study is needed in more racially and ethnically diverse populations “to understand the impact on the association of food environment and incident HF.”