Eating fewer foods of concern may protect the heart beyond pills

By Vijay Kumar MalesuReviewed by Susha Cheriyedath, M.Sc.Feb 10 2026

New evidence suggests that improving dietary quality complements cardioprotective medications, reinforcing diet as a central pillar of cardiovascular disease prevention.

Study: Foods of concern, cardiopreventive medication use and risk of cardiovascular diseases: a prospective study in the CARTaGENE cohort. Image Credit: Rimma Bondarenko / Shutterstock

In a recent study accepted as a journal pre proof in The American Journal of Clinical Nutrition, researchers evaluated whether lower consumption of foods of concern, defined by food processing level or front of package warning labels, is associated with reduced cardiovascular disease risk independent of cardioprotective medication use.

Cardiovascular Disease Burden and Dietary Concerns

Cardiovascular disease causes nearly one in three deaths worldwide, and in Canada alone, it accounts for approximately 14 deaths every hour, placing substantial strain on health systems and families. Although medications for high blood pressure and high cholesterol are widely prescribed, everyday dietary choices remain a powerful determinant of cardiovascular health.

In response, Canada has introduced front-of-package nutrition symbols for foods high in saturated fat, sodium, and sugars. At the same time, there is increasing concern about ultra-processed foods, which now dominate many modern diets. Whether warning labels fully capture harmful foods and whether medications can offset poor dietary patterns remain uncertain, underscoring the need to understand how diet and pharmacotherapy interact in real-world cardiovascular prevention.

Cohort Design, Dietary Assessment, and Medication Use

This prospective cohort analysis was conducted within the CARTaGENE population-based study in Québec, Canada. Participants aged 40 to 69 years who completed dietary assessments and reported physician-diagnosed hypertension or hypercholesterolemia were eligible. Individuals with prior myocardial infarction, stroke, cancer, or diabetes were excluded.

Dietary intake over the previous year was assessed using the validated Canadian Dietary History Questionnaire II. Foods were classified by degree of processing using the Nova system, identifying ultra-processed foods, and by nutritional risk using Health Canada criteria for front-of-package nutrition symbols applied to foods high in saturated fat, sodium, or sugars.

Consumption was expressed as the percentage share of the total daily diet by weight (grams per day), allowing a substitution-based interpretation in which lower intake of foods of concern corresponds to higher intake of other foods. Use of blood pressure- and cholesterol-lowering medications was self-reported and classified according to the Anatomical Therapeutic Chemical (ATC) system.

The outcome was incident cardiovascular disease, defined as the first occurrence of myocardial infarction, stroke, or cardiovascular death identified through linked administrative health data using International Classification of Diseases (ICD) codes. Multivariable Cox proportional hazards models adjusted for age, sex, income, smoking status, physical activity, alcohol intake, total energy intake, and body mass index.

Associations Between Foods of Concern and Cardiovascular Events

The analysis included 2,123 adults followed for a mean of 9.3 years, during which 179 cardiovascular events occurred. Up to 41 percent of the daily diet by weight consisted of ultra-processed foods, while 38 percent of total caloric intake came from foods carrying front-of-package nutrition symbols, underscoring the prevalence of these foods even among individuals aware of cardiovascular risk.

Lower consumption of foods of concern was associated with a reduced risk of cardiovascular disease. A 10 percent reduction in dietary intake of ultra-processed foods, measured by weight, was associated with approximately a 13 percent lower hazard of cardiovascular disease. A similar reduction in risk was observed for foods bearing front-of-package warning symbols.

Although food processing level and nutrient warning labels identify overlapping but not identical food categories, both approaches showed comparable associations with cardiovascular risk. Associations were weaker when exposures were defined as a percentage of calories rather than grams per day, suggesting that methodological choices in dietary exposure definition influence effect estimates.

Participants with lower intake of foods of concern also consumed fewer total calories. They had lower intakes of saturated fat and sodium, supporting links between overall dietary quality and cardiometabolic health. Findings were consistent across sensitivity analyses and in subgroup analyses restricted to participants with hypertension or hypercholesterolemia.

Medication Use Does Not Offset Dietary Associations

Use of cardioprotective medications did not modify the association between diet and cardiovascular risk. Although use of cholesterol-lowering medications was associated with lower cardiovascular risk, blood pressure-lowering medications alone showed no clear protective association in this observational analysis, likely reflecting confounding by indication rather than lack of efficacy.

No evidence was found that medication use attenuated the protective association between lower consumption of foods of concern and cardiovascular disease risk across multiple interaction metrics, including relative excess risk due to interaction, attributable proportion due to interaction, and additive interaction measures.

From a practical perspective, individuals taking cardioprotective medications continued to experience additional benefits from reducing intake of ultra-processed foods and foods high in sodium, added sugars, and saturated fat. These findings suggest that medication and dietary improvements act independently rather than as substitutes, although residual confounding and dietary measurement limitations inherent to cohort studies should be acknowledged.

Interpretation and Public Health Implications

Among adults with hypertension or hypercholesterolemia, lower consumption of foods of concern, whether defined by ultra-processed or front-of-package nutrition symbols, was associated with significantly lower cardiovascular disease risk. These associations persisted regardless of medication use, indicating that pharmacological treatment complements rather than replaces healthy dietary patterns.

The findings support the role of food labeling in identifying higher-risk dietary patterns while reinforcing concerns about the regular consumption of ultra-processed foods. For individuals, clinicians, and policymakers, the results underscore the importance of combining dietary improvement with pharmacological management as part of comprehensive cardiovascular disease prevention strategies, noting that the results derive from a middle-aged Québec cohort and may not fully generalize to other populations.