Sarcouncil Journal of Internal Medicine and Public Health

Abstract: Cardiovascular disease (CVD) continues to be the most common cause of death in the United States of America. This problem disproportionately affects underserved populations. In these populations, diabetes mellitus, hypertension, and food insecurity are highly prevalent and tend to co-occur. This may lead to a potential interaction effect on CVD outcomes. This narrative review synthesizes epidemiological, biological, behavioral, and policy-based evidence on the interaction of these conditions on CVD outcomes in underserved American populations. Diabetes mellitus and hypertension are known to co-occur through common pathophysiological pathways. In contrast, food insecurity may co-occur with diabetes mellitus and hypertension through factors such as dietary habits, chronic psychosocial stress, disease self-management, and healthcare access. Nationally representative surveys and studies have shown that food insecurity correlates with poor management of cardiometabolic conditions, increased rates of cardiovascular disease, particularly among individuals with diabetes mellitus and hypertension. Though interaction studies are scarce, existing evidence supports a syndemic effect of these conditions on CVD outcomes in underserved American populations. Integrated prevention strategies addressing both cardiometabolic conditions and food insecurity are essential to reducing persistent cardiovascular disparities.