Neighborhood Access to Healthy Food Affects Residents’ Risk of Atherosclerosis

Having more access to neighborhood stores that sell healthy food may slow the development of coronary atherosclerosis, according to the results of a new study.

“The lack of healthy food stores may help explain why people in neighborhoods with limited access have more heart disease,” Jeffrey J. Wing, PhD, MPH (Grand Valley State University, Grand Rapids, MI), told TCTMD in an email. “The thought is that greater access to healthier foods may have promoted healthier diets and, in turn, less coronary plaque formation. [This] would, hopefully in the future, lead to less cardiovascular events like stroke or heart attacks.” 

The study, which is published online August 15, 2016 in Circulation, is an analysis of 5,950 adults from the Multi-Ethnic Study of Atherosclerosis (MESA) who were followed for a 12-year period. As part of the study, the researchers examined the effect of neighborhood characteristics on the progression of subclinical atherosclerosis as measured by coronary artery calcium (CAC). They assessed the relationship between CAC and factors such as density of recreational facilities, density of healthy food stores, and survey-based measures of healthy food availability, walking environment, and social environment. 

At baseline, the mean CAC was 135, and 51% of participants had zero CAC. People living in neighborhoods with higher levels of social cohesion and safety were more likely to have zero CAC compared with those in neighborhoods with low social cohesion and safety. 

As the density of neighborhood healthy food stores increased, CAC scores decreased. The association remained after adjusting for time-varying behavioral risk factors and depression. However, changes across time in the other neighborhood factors examined in the study did not yield any significant association with change in CAC. 

Previous studies have found relationships between neighborhood characteristics and cardiovascular disease. We hypothesized that any of these measures that we tested could be responsible,” Wing said. “Finding that the density of healthy food stores was the only factor among those tested that consistently was related to slowing the progression of coronary calcium build-up was interesting in that we didn’t see the same relation with other neighborhood features.”

Food Trucks and Farmers’ Markets

In an editorial accompanying the study, Adelaida Rosario, PhD, and Eliseo Perez-Stable, MD (National Institutes of Health, Bethesda, MD), call the study “an advancement of knowledge toward understanding” what is a very complex topic. 

“Given that neighborhood environments are likely to impact health outcomes through various interrelated mechanisms, the most effective interventions are likely to be those that can influence changes across multiple dimensions,” state the editorialists. Knowing more about what neighborhood characteristics can be targeted, they say, is essential for the development of effective interventions to prevent coronary heart disease and other conditions.

According to the researchers, including coinvestigator Ella August, PhD (University of Michigan School of Public Health, Ann Arbor, MI), it was important to examine specific neighborhood exposures and their relationship with subclinical atherosclerosis in order to identify pathways for intervention.

“There are several great models out there helping to provide access to those in need, but none have been implemented on a big scale,” August told TCTMD in an email. “For example, mobile urban produce vendors sell fresh produce in urban underserved areas. Many are converted school buses or trucks that drive through city streets offering apples, lettuce, and carrots. Ice cream trucks have followed this model successfully for years, and these mobile produce vendors have been cropping up on a very small scale in different cities across the country.”

In addition, people are now able to use Supplemental Nutrition Assistance Program (SNAP) at farmers’ markets, August said. Unfortunately, there are not always a lot of farmers’ markets in poor urban areas.


  • Wing JJ, August W, Adat SD, et al. Change in neighborhood characteristics and change in coronary artery calcium. A longitudinal investigation in the MESA (Multi-Ethnic Study of Atherosclerosis) Cohort. Circulation. 2016;Epub ahead of print.
  • Rosario AM, Perez-Stable EJ. Making neighborhoods good for your health. Circulation. 2016;Epub ahead of print.


  • August and Wing report no relevant conflicts of interest.

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