ArticleThe American journal of clinical nutrition2026
Foods of concern, cardiopreventive medication use and risk of cardiovascular diseases: a prospective study in the CARTaGENE cohort.
Article in The American journal of clinical nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn Canada, by 2026, prepackaged foods high in saturated fat, sodium, or sugar require a front-of-package warning symbol (FOPS). However, evidence on ultraprocessed foods (UPFs) raises concerns about whether this approach fully captures all foods of concern-particularly for individuals with hypertension or hypercholesterolemia, for whom dietary changes are crucial. It is also important to assess whether medication use diminishes the benefits of limiting such foods.
objectivesWe examined the joint association of consuming foods of concern-defined as UPFs or foods with FOPS-medication use, and cardiovascular disease (CVD) risk in adults with hypertension and/or hypercholesterolemia from the CARTaGENE cohort.
methodsThis prospective cohort study included 2123 participants free of CVD but with hypertension and/or hypercholesterolemia at baseline (2009-2010). Using food frequency questionnaire (FFQ) data (2012), UPFs were identified using Nova, and foods with FOPS using Health Canada criteria. Cholesterol- and blood pressure-lowering medication use was self-reported. Incident CVDs were identified using administrative databases, from FFQ completion to 31 December, 2021. Associations between intake of foods of concern, medication use, and CVD risk were assessed using multivariable-adjusted Cox proportional hazards models.
resultsIn multivariable-adjusted analyses-including medication use, energy intake, and BMI-the hazard ratio (HR) for CVD risk associated with a 10% lower difference in UPF consumption-accompanied by a proportional higher difference in non-UPF-was 0.87 [95% confidence interval (CI): 0.78, 0.97]. For foods with FOPS, the corresponding HR was 0.80 (95% CI: 0.70, 0.93), with no evidence that this estimate differed significantly from that for UPF (P = 0.42). There was no evidence of departure from additivity between medication use and the consumption of foods of concern relative to CVD risk.
conclusionsIn individuals with hypertension or hypercholesterolemia, lower consumption of UPFs or foods with FOPS was similarly associated with lower CVD risk, independent of concomitant medication use.
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