Ultra Processed Food and Heart Disease: What Research Says
An evidence-based review of epidemiological research examining associations between ultra-processed food consumption and cardiovascular disease risk, including key studies, proposed mechanisms, and important limitations.
Medical Disclaimer
This guide is for educational purposes only and is not medical or cardiology advice. Cardiovascular disease risk is influenced by genetics, blood pressure, cholesterol, smoking, physical activity, and many factors beyond diet composition. The studies cited are primarily observational. Always consult a cardiologist or qualified healthcare provider for heart health concerns.
Cardiovascular Disease and the UPF Question
Cardiovascular disease (CVD) is the leading cause of death globally, responsible for an estimated 17.9 million deaths annually according to the World Health Organization. In the United States alone, heart disease accounts for roughly one in every five deaths. The established risk factors -- high blood pressure, high LDL cholesterol, smoking, diabetes, obesity, and physical inactivity -- are well-documented and supported by decades of clinical research.
In recent years, a growing body of epidemiological research has begun examining whether ultra-processed food consumption may represent an additional contributing factor to cardiovascular risk. This research sits alongside -- not above -- the established evidence on traditional risk factors. The studies are primarily observational, meaning they identify statistical associations rather than proving direct causation.
This guide summarizes the current epidemiological evidence linking UPF consumption to cardiovascular outcomes, describes potential biological pathways under investigation, and places these findings in the context of established cardiovascular science. For a broader overview of UPF research across all health outcomes, see our comprehensive health effects guide.
Important context: The research summarized below identifies associations between UPF consumption and cardiovascular outcomes in large populations. These associations do not establish that UPFs directly cause heart disease. Many confounding factors -- including overall diet quality, socioeconomic status, and lifestyle habits -- may partially explain the observed relationships.
Key Epidemiological Studies
Several large prospective cohort studies have examined the relationship between ultra-processed food consumption and cardiovascular disease outcomes. While each study has limitations, the consistency of findings across different populations and methodologies has drawn significant attention from the cardiology and nutrition research communities.
NutriNet-Sante Cohort (Srour et al., BMJ, 2019)
Participants: 105,159 French adults followed for a median of 5.2 years
Key finding: A 10% increase in the proportion of UPFs in the diet was associated with a 12% higher risk of overall cardiovascular disease (HR 1.12, 95% CI 1.05-1.20), a 13% higher risk of coronary heart disease, and an 11% higher risk of cerebrovascular disease
Limitation: Self-reported dietary data using 24-hour records; predominantly female participants (79%), which may limit generalizability
Italian Moli-sani Cohort (Bonaccio et al., BMJ, 2021)
Participants: 22,895 Italian adults followed for a median of 12.2 years
Key finding: Participants in the highest quartile of UPF consumption had a 58% higher risk of cardiovascular mortality (HR 1.58, 95% CI 1.23-2.03) and a 26% higher risk of all-cause mortality compared to the lowest quartile
Limitation: Single dietary assessment at baseline; participants were from a single Italian region, which may not reflect broader dietary patterns
US NHANES Analysis (Juul et al., AJCN, 2021)
Participants: Nationally representative US sample from NHANES cycles, approximately 11,000 adults
Key finding: Higher UPF consumption was associated with increased risk of cardiovascular disease mortality, with a dose-response relationship observed across consumption quartiles
Limitation: Dietary intake based on two 24-hour recalls, which may not capture habitual intake; relatively short follow-up for some participants
UK Biobank Analysis (Rauber et al., 2022)
Participants: Over 200,000 UK adults from the UK Biobank prospective cohort
Key finding: Each 10 percentage point increase in UPF calorie intake was associated with a 6% higher risk of cardiovascular disease incidence, with stronger associations observed for cerebrovascular disease
Limitation: Dietary data from web-based 24-hour recalls completed by a subset of participants; potential healthy volunteer bias in the UK Biobank population
BMJ Umbrella Review of Meta-Analyses (Lane et al., BMJ, 2024)
Scope: Systematic umbrella review pooling 45 meta-analyses covering nearly 10 million participants
Key finding: Rated the evidence linking UPF consumption to cardiovascular disease-related mortality as “convincing” -- the highest evidence grade for observational data. Found associations with 32 adverse health outcomes overall
Limitation: An umbrella review inherits the limitations of its underlying studies; “convincing” observational evidence is not equivalent to causal proof from randomized trials
Research Summary: UPF and Cardiovascular Outcomes
The following table summarizes key studies examining associations between ultra-processed food consumption and cardiovascular disease. All findings represent observational associations, not established causal relationships.
| Study | Year | Participants | CVD Outcome | Risk Association | Key Limitation |
|---|---|---|---|---|---|
| NutriNet-Sante (Srour et al.) | 2019 | 105,159 | Overall CVD, coronary heart disease | +12% per 10% increase in UPF intake | 79% female; self-reported diet |
| Moli-sani (Bonaccio et al.) | 2021 | 22,895 | CVD mortality, all-cause mortality | +58% CVD mortality (highest vs. lowest quartile) | Single baseline assessment; one region |
| US NHANES (Juul et al.) | 2021 | ~11,000 | CVD mortality | Dose-response across quartiles | Two 24-hour recalls; shorter follow-up |
| UK Biobank (Rauber et al.) | 2022 | 200,000+ | CVD incidence, cerebrovascular disease | +6% per 10pp increase in UPF calories | Subset dietary data; volunteer bias |
| BMJ Umbrella Review (Lane et al.) | 2024 | ~10 million (pooled) | CVD mortality (rated “convincing”) | Consistent across 45 meta-analyses | Inherits limitations of underlying studies |
| JACC Meta-Analysis (2022) | 2022 | Multiple cohorts pooled | CVD events | +6% CVD risk per 10% UPF increase | Heterogeneity in NOVA application across studies |
Interpreting risk estimates: A “12% higher risk” means that in the studied population, the group with higher UPF intake had a relative risk 1.12 times that of the comparison group. This is a modest effect size compared to established risk factors. For comparison, smoking increases cardiovascular disease risk by approximately 200-400%, and uncontrolled high blood pressure increases risk by approximately 100-200%.
Potential Pathways Under Investigation
Researchers have proposed several biological mechanisms through which ultra-processed food consumption might contribute to cardiovascular risk. These are hypothesized pathways supported by varying degrees of evidence -- the causal chain from UPF consumption to cardiovascular events has not been established.
Sodium and Blood Pressure
Ultra-processed foods contribute an estimated 70% of sodium in the typical American diet, according to CDC data. High sodium intake is an established and well-documented risk factor for hypertension, which in turn is one of the strongest risk factors for cardiovascular disease. This pathway is the most straightforward connection between UPF consumption and cardiovascular risk -- not because of ultra-processing per se, but because UPFs happen to be the primary vehicle for excess sodium intake in modern diets.
Evidence level: Established -- the sodium-hypertension-CVD pathway is well-documented; UPFs as a sodium source is well-characterized
Trans Fats and Lipid Profiles
Although the FDA effectively banned partially hydrogenated oils (the primary source of artificial trans fats) in 2018, some ultra-processed foods may still contain small amounts of trans fats. Products can legally be labeled as “0g trans fat” if they contain less than 0.5g per serving. Cumulative intake from multiple servings across multiple products may still reach levels that affect lipid profiles. Trans fats raise LDL cholesterol and lower HDL cholesterol, directly increasing cardiovascular risk.
Evidence level: Established -- trans fat cardiovascular effects are proven; residual exposure through UPFs is documented but diminishing
Added Sugars and Metabolic Effects
Excessive added sugar intake is associated with dyslipidemia (abnormal blood lipid levels), insulin resistance, obesity, and type 2 diabetes -- all of which are independent cardiovascular risk factors. Ultra-processed foods are the primary source of added sugars in most Western diets. Sugar-sweetened beverages, in particular, have been consistently linked to cardiovascular outcomes across multiple studies independent of the broader UPF literature.
Evidence level: Strong -- the added sugar-metabolic syndrome-CVD pathway is well-supported by clinical evidence
Saturated Fat Content
Many ultra-processed foods -- including processed meats, baked goods, and ready-to-eat meals -- are high in saturated fat. While the relationship between saturated fat and cardiovascular disease has been debated in recent years, most major cardiology organizations, including the American Heart Association, continue to recommend limiting saturated fat intake to reduce LDL cholesterol and cardiovascular risk.
Evidence level: Strong -- saturated fat and LDL cholesterol relationship is established; role of UPFs as a source is documented
Inflammatory Effects of Additives
Emerging research is examining whether certain food additives commonly found in ultra-processed products -- including emulsifiers, artificial sweeteners, and some preservatives -- may promote chronic low-grade inflammation. Chronic inflammation is increasingly recognized as a contributor to atherosclerosis and cardiovascular events. Some animal studies have shown that emulsifiers like polysorbate 80 and carboxymethylcellulose can disrupt the gut microbiome and promote inflammatory responses, but human evidence remains limited. See our ingredients to avoid guide for more detail on specific additives.
Evidence level: Preliminary -- plausible mechanism supported by animal models; human evidence is early-stage
Obesity as a Mediating Factor
The NIH feeding trial (Hall et al., Cell Metabolism, 2019) demonstrated that ultra-processed diets lead to greater calorie consumption and weight gain compared to unprocessed diets matched for nutrient content. Obesity is one of the strongest modifiable risk factors for cardiovascular disease. It is possible that much of the observed association between UPFs and CVD is mediated through the obesity pathway -- that is, UPFs promote weight gain, and weight gain increases cardiovascular risk. This indirect pathway does not diminish the practical relevance of the association, but it does suggest that the mechanism may not involve direct cardiotoxicity of ultra-processed ingredients.
Evidence level: Moderate -- obesity-CVD link is established; UPF-obesity link is supported by the NIH RCT; the full mediation pathway is under investigation
Important note: Several of these pathways (sodium, added sugars, saturated fat) are related to the nutrient content of UPFs rather than ultra-processing itself. A central question in the field is whether ultra-processing confers cardiovascular risk beyond what would be predicted by nutrient composition alone. Some studies have found that associations persist after adjusting for nutrient content, but this remains an active area of investigation.
UPFs and Established CVD Risk Factors
Understanding how UPF consumption may interact with known cardiovascular risk factors provides context for interpreting the epidemiological evidence. The following table summarizes these potential connections and the strength of available evidence for each.
| Risk Factor | Established Evidence | UPF Connection | Strength of Evidence |
|---|---|---|---|
| High blood pressure | Leading modifiable CVD risk factor; strong causal evidence | UPFs contribute ~70% of dietary sodium; high sodium raises blood pressure | Established |
| High LDL cholesterol | Causal role in atherosclerosis; proven by genetic and drug-trial evidence | Some UPFs are high in saturated and trans fats, which raise LDL | Strong |
| Obesity | Major independent CVD risk factor; well-established | NIH RCT showed UPF diets drive excess calorie intake and weight gain | Strong |
| Type 2 diabetes | Significantly increases CVD risk; well-established | UPF consumption associated with diabetes risk in multiple cohorts; added sugars implicated | Moderate |
| Chronic inflammation | Contributes to atherosclerosis; measured by CRP and other markers | Some additives may promote inflammation; high UPF intake associated with elevated CRP in some studies | Preliminary |
| Excess sodium intake | Directly raises blood pressure; contributes to cardiac remodeling | UPFs are the dominant source of sodium in Western diets | Established |
Key nuance: Many of the connections between UPFs and cardiovascular risk factors are driven by nutrient composition (sodium, sugar, saturated fat) rather than ultra-processing itself. A central unresolved question is whether there are cardiovascular effects of ultra-processing that go beyond what nutrient profiles alone would predict. Some studies suggest yes, but the evidence is not conclusive.
What Major Health Organizations Recommend
While the research specifically linking UPFs to cardiovascular outcomes continues to develop, major health organizations have issued dietary recommendations that are relevant to this discussion. Notably, these recommendations are based on broader dietary science and are not exclusively driven by the UPF literature.
American Heart Association (AHA)
The AHA's dietary recommendations emphasize consuming a variety of fruits, vegetables, whole grains, lean proteins, nuts, and legumes while limiting added sugars (no more than 6% of total calories), sodium (less than 2,300 mg/day, ideally under 1,500 mg), saturated fat, and alcohol. These recommendations align with reducing many UPFs but are framed around nutrient targets rather than processing level.
In 2024, the AHA introduced a three-tier classification for ultra-processed foods, distinguishing between “industrially processed” foods (highest concern), “less processed” foods, and “minimally processed” foods. This approach acknowledges that not all UPFs are nutritionally equivalent and represents a more nuanced position than a blanket recommendation to avoid all processed foods.
World Health Organization (WHO)
The WHO dietary guidelines recommend limiting free sugars to less than 10% of total energy intake, reducing sodium intake to less than 2 g/day (equivalent to 5 g of salt), and replacing saturated fats with unsaturated fats. The WHO has also highlighted concerns about ultra-processed food consumption in the context of the global obesity epidemic and non-communicable disease burden. Some WHO regional offices have explicitly recommended reducing UPF consumption, though the global guidelines focus primarily on nutrient-level targets.
Evidence-Based Dietary Patterns
The Mediterranean diet and DASH (Dietary Approaches to Stop Hypertension) diet are the most extensively studied dietary patterns for cardiovascular health, with evidence from multiple randomized controlled trials -- not just observational studies. Both patterns emphasize whole, minimally processed foods and are naturally low in ultra-processed products. The PREDIMED trial, for example, demonstrated that a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced cardiovascular events by approximately 30% compared to a control diet. These dietary patterns align with reducing UPFs, but their evidence base is independent of and stronger than the UPF-specific research. For more context on food classification systems, see our NOVA food classification guide.
Practical Perspective
Given the current state of the evidence, how should the UPF-cardiovascular research inform practical decisions? The following points aim to place this research in a balanced and actionable context.
Established Risk Factors Come First
Smoking cessation, blood pressure management, cholesterol management, regular physical activity, and maintaining a healthy weight have far stronger evidence for reducing cardiovascular disease risk than any findings from the UPF literature. These should remain the primary focus of cardiovascular risk reduction. The relative risk increases associated with UPF consumption (6-12% per 10% increase in intake) are modest compared to the risk increases from smoking (200-400%) or uncontrolled hypertension (100-200%).
Reducing UPFs May Complement Heart-Healthy Eating
The dietary patterns with the strongest evidence for cardiovascular benefit -- the Mediterranean diet and DASH diet -- are naturally low in ultra-processed foods. Reducing UPF consumption may be a practical way to move toward these evidence-based patterns, even if the independent cardiovascular effect of reducing processing level remains uncertain. Replacing UPFs with whole foods typically reduces sodium, added sugar, and saturated fat intake simultaneously. See our guide to reducing UPFs for practical strategies.
Not All UPFs Affect Cardiovascular Risk Equally
Research consistently shows that different UPF subcategories have different associations with cardiovascular outcomes. Sugar-sweetened beverages and processed meats show the strongest negative associations, while whole-grain breads with preservatives show weaker or null associations. A practical approach would prioritize reducing the highest-concern subcategories rather than attempting to eliminate every product classified as ultra-processed. See our food swaps guide for specific alternatives.
Consult Your Cardiologist
Population-level research describes trends across large groups and cannot predict individual risk. Your personal cardiovascular risk depends on your family history, blood pressure, cholesterol levels, blood sugar, weight, activity level, smoking status, and many other factors. A cardiologist or primary care physician who knows your medical history is the best resource for determining which dietary and lifestyle changes would be most beneficial for your individual situation.
Final reminder: This guide summarizes published epidemiological research. It is not a substitute for professional medical or cardiology advice. The research is observational, the effect sizes are modest relative to established risk factors, and the field is still developing. Please consult qualified healthcare professionals for guidance specific to your cardiovascular health.
Frequently Asked Questions
Does ultra-processed food cause heart disease?
Multiple large observational studies have found statistical associations between higher ultra-processed food consumption and increased cardiovascular disease risk. However, observational studies cannot prove causation. People who consume more UPFs may also differ in other ways that affect heart health, such as physical activity levels, smoking status, and socioeconomic factors. The 2024 BMJ umbrella review rated the evidence for cardiovascular disease mortality as "convincing," which is the highest grade for observational evidence but still falls short of proof from randomized controlled trials. Consult a cardiologist or healthcare provider for personalized heart health guidance.
How much does UPF consumption increase cardiovascular risk according to studies?
Risk estimates vary by study. The NutriNet-Sante cohort (Srour et al., BMJ, 2019) found that a 10% increase in the proportion of UPFs in the diet was associated with a 12% higher risk of overall cardiovascular disease. The Moli-sani study (Bonaccio et al., BMJ, 2021) found that participants in the highest quartile of UPF consumption had a 58% higher risk of cardiovascular mortality compared to the lowest quartile. These are relative risk increases observed in specific populations and may not translate directly to individual risk. Established risk factors like smoking, high blood pressure, and high cholesterol have considerably stronger evidence for cardiovascular impact.
Is reducing ultra-processed food more important than other heart-healthy changes?
No. Established cardiovascular risk factors -- including high blood pressure, high LDL cholesterol, smoking, physical inactivity, obesity, and diabetes -- have far stronger evidence for contributing to heart disease. Medical guidelines from the American Heart Association and other organizations prioritize managing these risk factors. Reducing UPF consumption may complement proven heart-healthy habits such as regular exercise, not smoking, and following dietary patterns like the Mediterranean or DASH diet, but it should not replace attention to established risk factors. Talk to your cardiologist about which changes would be most impactful for your individual situation.
Do all ultra-processed foods affect heart health equally?
Research suggests they do not. Studies that have examined UPF subcategories find that sugar-sweetened beverages and processed meats show the strongest associations with cardiovascular risk, while ultra-processed breads and cereals show weaker or null associations. A whole-grain bread with added emulsifiers and a can of soda are both classified as NOVA Group 4, but their nutrient profiles and apparent health associations differ substantially. This subcategory variation is one reason some researchers advocate for more nuanced classification systems beyond the current NOVA framework.
What dietary patterns are recommended for heart health?
The American Heart Association recommends dietary patterns emphasizing fruits, vegetables, whole grains, lean proteins, nuts, and legumes while limiting added sugars, sodium, saturated fat, and alcohol. The Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet both have strong evidence for cardiovascular benefit from multiple randomized controlled trials. These patterns naturally tend to be lower in ultra-processed foods, though the evidence supporting them is based on food composition and nutrient intake rather than degree of processing per se. A registered dietitian or cardiologist can help you develop a heart-healthy eating plan tailored to your needs.
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Disclaimer: All tools and data visualizations are provided for educational and informational purposes only. They are not intended as health, medical, or dietary advice. Product formulations change frequently — always check the actual label for current ingredients and nutrition facts before making purchasing decisions. Consult healthcare professionals for personalized dietary guidance.