Ultra-processed foods linked to 67% higher risk of heart attack and stroke

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.