Heart Health in America

And why we authored this book

The Problem

Heart disease is the #1 cause of death in the United States (US) [1].


In the US, every 33 seconds, one person dies from a heart-related condition [1].


Key risk factors for developing heart disease include high cholesterol and high blood pressure [2], conditions that are both sensitive to lifestyle and eating patterns[3].

The Role of Food

In the United States, greater adherence to a Western/unhealthy diet (one high in red and processed meat, refined grains, sweets, desserts, eggs, and high-fat dairy) has been associated with a 45% increased risk of coronary heart disease (CHD) [4]. Note that CHD is the most common type of heart disease in the United States [5].

Some Diets Contribute to Heart Disease

Some Diets Help Prevent Heart Disease

A study published in the European Heart Journal – Quality of Care and Clinical Outcomes found that over two-thirds of heart disease deaths worldwide could be prevented with healthier diets [6].

In another study, individuals who consistently followed healthy eating patterns had a 14% to 21% lower risk of developing heart disease during the period they were tracked [7].

So what is Heart-Healthy Eating?

The American Heart Association (AHA) has identified diet patterns that are most conducive to heart health These include the Mediterranean, DASH, pescetarian, and ovo/lacto-vegetarian diets. Our cookbook adheres to the DASH diet guidelines, explained on page 162 of the book. For more information on the AHA’s dietary recommendations, click the button below [8]:

The Inequality Behind the Illness:

Barriers to Care, Coverage, and Nutrition 

Poverty and Education Levels Impact Heart Disease

SES and Heart Attack Risk: A 2025 analysis of 20 years of data found that adults in the United States who were low-income and did not finish college had far greater odds of heart disease than their high-income, college-educated peers. In the low SES group, people were more than two times more likely to get a heart attack compared to the wealthier, educated group [9].

Left Behind in Prevention: Lower SES Americans have not benefited equally from overall advances in cardiovascular prevention and treatment. Between 1999 and 2016, cardiovascular disease prevalence declined substantially among the top 20% of earners but barely improved (or even worsened) for the other 80%. In the highest-income group, rates of conditions like heart attack and heart failure fell by more than half, whereas in the rest of the population, heart attack prevalence inched down slightly, and heart failure and stroke rates actually increased over that period [10].

Insurance Coverage Can Be Life or Death

About 14.5% of non-elderly adults with suffer from cardiovascular disease (CVD) or cardiovascular risk factors (CVRF) have no health insurance [11].

Missed Chances to Catch and Treat Disease: Lacking insurance coverage often means forgoing preventive care and treatments. Data from the Center for Disease Control (CDC) show that uninsured adults are far less likely to receive key preventive services (e.g., blood pressure checks, cholesterol screening, or management for diabetes), all of which are essential for cardiovascular risk reduction [12].

When Care Comes Too Late, or Not at All: A lack of access to insurance doesn’t just affect how fast conditions are identified; it also affects how effectively they are treated. A national study of 14.7 million heart failure hospitalizations found that uninsured patients had 13% higher odds of in-hospital death compared to insured patients and were significantly less likely to receive life-saving interventions, despite facing higher hospitalization costs [13]. 

Knowing How to Eat Healthy Isn’t So Simple

The Role of Health Literacy in Health Disparities: One powerful way socioeconomic status contributes to worsened health outcomes is through its impact on the attainment of health literacy (HL), which is the ability to comprehend and apply basic health information. Disadvantaged socioeconomic conditions have been shown to lead to diminished HL, which has been shown to mediate the relationship between low SES and adverse health outcomes [14]. Unfortunately, nearly 9 out of 10 adults in the U.S. struggle with health literacy, making HL a prime target for intervention and study on its impact on heart health [15].

Why Health Literacy Matters for Heart-Healthy Eating:  Knowing how to choose and prepare heart-healthy foods requires HL, and is an essential step in eating to prevent heart disease, since nutrition knowledge helps people make informed food decisions. A 2014 study found that young adults with low HL were unlikely to use nutrition labels to select food products and were more likely to report an unhealthy diet [16].

SES and Diet: Health literacy is just one obstacle associated with healthy eating among individuals with low socioeconomic status (SES).

Healthy Eating is not Cheap: Studies show that following a heart-healthy diet, like the one recommended by national guidelines, can cost two to three times more than what a low-income family typically spends on food [17]. When budgets are tight, families are more likely to purchase less healthy, high-calorie foods, as this is the most cost-effective way to fill hungry stomachs [18]

Your Zip Code Shapes Your Grocery Options: Low-income neighborhoods are less likely to have large and accessible grocery stores [19] and more likely to have fast food chains or convenience stores that charge higher prices for fresh food [20]. This means that people in lower-SES communities often pay more per item for nutritious food, and have to travel farther to get it.

Food Insecurity and Heart Failure: Food insecurity, meaning not having reliable access to enough affordable, nutritious food, has been linked to worse heart health. In a study of nearly 3,000 U.S. counties, the American Heart Association found that places with higher food insecurity (where 13.7% or more of residents struggled to afford food) had more deaths from heart failure. Specifically, those counties saw about 31 heart failure deaths for every 100,000 people, compared to 27 deaths per 100,000 in more food-secure areas [21].

Why we Made this Book

We believe that increasing health literacy can help people make better choices with the resources they have available.

Given the significant influence of diet on cardiovascular health, we also believe there is value in designing recipes that are as accessible as possible, even if not perfect. Affordability, ease, and cultural relevance can make heart-healthy eating more realistic—and more likely to stick.

At the same time, we recognize that long-term progress requires addressing the broader social and economic barriers that shape heart health. From food deserts to healthcare access, many challenges lie beyond the kitchen. We hope this cookbook sparks both practical change and broader advocacy. We encourage policymakers, clinics, schools, and community organizations to build on projects like ours to help reduce the systemic inequities driving heart disease.

We envision a world where heart-healthy food is truly accessible to all. If you’d like to support that mission, consider donating to organizations working to improve food access and health equity. You can find one of them on our Support the Cause page—linked in the header or by clicking the button below.

References

  1. CDC. Multiple Cause of Death Data on CDC WONDER [Internet]. wonder.cdc.gov. 2024. Available from: https://wonder.cdc.gov/mcd.html

  2. Centers for Disease Control and Prevention. Heart Disease Risk Factors [Internet]. Heart Disease. CDC; 2024. Available from: https://www.cdc.gov/heart-disease/risk-factors/index.html

  3. National Heart, Lung and Blood Institute. Risk Factors [Internet]. NHLBI, NIH. 2024. Available from: https://www.nhlbi.nih.gov/health/coronary-heart-disease/risk-factors

  4. Hou L, Li F, Wang Y, Ou Z, Xu D, Tan W, et al. Association between dietary patterns and coronary heart disease: a meta-analysis of prospective cohort studies. International Journal of Clinical and Experimental Medicine [Internet]. 2015 Jan 15;8(1):781. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4358513/

  5. CDC. About Coronary Artery Disease (CAD) [Internet]. Heart Disease. 2024. Available from: https://www.cdc.gov/heart-disease/about/coronary-artery-disease.html

  6. Dai H, Much AA, Maor E, Asher E, Younis A, Xu Y, et al. Global, regional, and national burden of ischaemic heart disease and its attributable risk factors, 1990–2017: results from the Global Burden of Disease Study 2017. European Heart Journal - Quality of Care and Clinical Outcomes. 2020 Oct 5;8(1):50–60

  7. Shan Z, Li Y, Baden MY, Bhupathiraju SN, Wang DD, Sun Q, et al. Association Between Healthy Eating Patterns and Risk of Cardiovascular Disease. JAMA Internal Medicine. 2020 Aug 1;180(8):1090.

  8. American Heart Association. Healthy Eating [Internet]. www.heart.org. 2019. Available from: https://www.heart.org/en/healthy-living/healthy-eating

  9. Parker D. Study reveals widening heart disease disparities in the US [Internet]. The Source. 2025 [cited 2025 Jun 3]. Available from: https://source.washu.edu/2025/03/study-reveals-widening-heart-disease-disparities-in-the-us/

  10. Abdalla SM, Yu S, Galea S. Trends in Cardiovascular Disease Prevalence by Income Level in the United States. JAMA Network Open [Internet]. 2020 Sep 25;3(9):e2018150. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770958

  11. Breaking Down the Barriers The Uninsured with Heart Disease and Stroke [Internet]. Available from: https://www.heart.org/en/-/media/Files/About-Us/Policy-Research/Fact-Sheets/Access-to-Care/Uninsured-with-CVD-and-Stroke.pdf?sc_lang=en

  12. Schober SE, Makuc DM, Zhang C, Kennedy-Stephenson J, Burt V. Health insurance affects diagnosis and control of hypercholesterolemia and hypertension among adults aged 20-64: United States, 2005-2008. NCHS data brief [Internet]. 2011 Jan;(57):1–8. Available from: https://pubmed.ncbi.nlm.nih.gov/21592420/

  13. Nebuwa C, Ndakotsu A, Ugoala O, Iyeku A, Mandal D. Association Between Insurance Status And In-hospital Outcomes In Patients With Heart Failure. Journal of Cardiac Failure [Internet]. 2025 Jan 14;31(1):255. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1071916424006134

  14. Stormacq C, Van den Broucke S, Wosinski J. Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review. Health Promotion International. 2018 Aug 9;34(5):e1–17.

  15. Agness C, Murrell E, Nkansah N, McHenry C. Poor Health Literacy as a Barrier to Patient Care. The Consultant Pharmacist. 2008 May 1;23(5):378–86.

  16. CDC. Food Literacy [Internet]. Health Literacy. 2024. Available from: https://www.cdc.gov/health-literacy/php/research-summaries/food-literacy.html

  17. Cha E, Kim KH, Lerner HM, Dawkins CR, Bello MK, Umpierrez G, et al. Health Literacy, Self-efficacy, Food Label Use, and Diet in Young Adults. American Journal of Health Behavior [Internet]. 2014 May 1;38(3):331–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039409/

  18. Utah State University. Does Healthy Eating Cost More? [Internet]. extension.usu.edu. 2023. Available from: https://extension.usu.edu/nutrition/research/does-healthy-eating-cost-more

  19. Hilmers A, Hilmers DC, Dave J. Neighborhood Disparities in Access to Healthy Foods and Their Effects on Environmental Justice. American Journal of Public Health [Internet]. 2022 Sep;102(9):1644–54. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482049/

  20. Gosliner W, Brown DM, Sun BC, Woodward-Lopez G, Crawford PB. Availability, quality and price of produce in low-income neighbourhood food stores in California raise equity issues. Public Health Nutrition [Internet]. 2018 Mar 15;21(9):1639–48. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962882/

  21. Keerthi Gondi, Larson J, Sifuentes A, Alexander NB, Konerman MC, Thomas KS, et al. Health of the Food Environment Is Associated With Heart Failure Mortality in the United States. Circulation: Heart Failure. 2022 Dec 1;15(12).