People whose diets contain the greatest amounts of ultra-processed food may face a significantly higher risk of cardiovascular disease than those who eat the least, according to a major review of long-term health studies.
The research combined evidence from 22 prospective studies and found that the highest consumers had a 17% greater risk of overall cardiovascular disease. Their risk of coronary heart disease was 23% higher, while the risk of stroke was approximately 9% higher.
The findings strengthen concerns about diets dominated by soft drinks, processed meats, packaged snacks and ready-to-eat meals. However, the evidence remains observational, meaning it shows a strong association rather than proving that industrial processing alone directly causes heart disease.
What Counts as Ultra-Processed Food?
Ultra-processed foods are industrial formulations that usually contain ingredients rarely used in an ordinary home kitchen.
They may include flavor enhancers, emulsifiers, artificial colors, sweeteners, modified starches, preservatives and protein isolates. Common examples include sugary drinks, packaged cakes, confectionery, instant noodles, processed meats, frozen meals and many fast-food products.
The category is based on the NOVA food-classification system. It distinguishes ultra-processed products from minimally processed foods such as fruit, vegetables, eggs, milk, rice, oats, nuts and fresh meat.
Processing itself is not automatically harmful. Freezing vegetables, pasteurizing milk or canning beans can make food safer and more convenient without turning it into an ultra-processed product.
What the Review Found
Researchers analyzed three large U.S. studies involving health professionals and combined the results with evidence from prospective studies conducted in other countries.
Across the wider meta-analysis, people in the highest category of ultra-processed food intake had a 17% higher risk of cardiovascular disease than those in the lowest category. The difference was larger for coronary heart disease, which includes conditions caused by narrowed or blocked arteries supplying the heart.
The evidence quality was assessed as high for coronary heart disease, moderate for overall cardiovascular disease and low for stroke. This means confidence in the size and reliability of the association was not identical for every outcome.
A separate dose-response analysis also found that cardiovascular-event risk generally increased as ultra-processed food consumption rose.
Not Every Ultra-Processed Food Showed the Same Risk
One of the most important findings was that ultra-processed foods did not behave as a single, uniform group.
Sugar-sweetened and artificially sweetened drinks were associated with higher cardiovascular risk. Processed meats also showed an unfavorable relationship.
However, some products classified as ultra-processed, including certain breads, cold cereals and yogurt-based products, were not associated with the same increased risk and sometimes showed inverse associations in the analyzed populations.
This does not mean every packaged cereal or yogurt protects the heart. It shows why judging a food only by its processing category may sometimes oversimplify its nutritional value.
A whole-grain packaged bread containing useful fiber is nutritionally different from a sugary drink, even when both meet parts of the technical definition of ultra-processed food.
Why These Foods May Affect the Heart
Many ultra-processed diets contain large amounts of sodium, added sugar and refined carbohydrates while supplying relatively little fiber.
Excess sodium can contribute to high blood pressure. Large amounts of refined carbohydrates and added sugar can promote weight gain, insulin resistance and type 2 diabetes. Low fiber intake may also affect cholesterol levels, blood-sugar control and the gut microbiome.
Ultra-processed foods are often designed to be soft, convenient and highly palatable. They can be eaten rapidly and may deliver substantial calories before the body produces a strong sensation of fullness.
Some researchers are also investigating whether additives, emulsifiers, packaging chemicals and changes to the physical structure of food could independently influence inflammation, metabolism or gut health. Those mechanisms remain active areas of research and are not equally established.
The Diet Around the Food Also Matters
People who eat the most ultra-processed food may differ from lower consumers in several other ways.
They may consume fewer fruits, vegetables, legumes and whole grains. They may also have different income levels, working hours, healthcare access, smoking habits or physical-activity patterns.
Researchers adjust their statistical models for many of these differences, but observational studies cannot remove every possible source of confounding.
The higher risk may result from a combination of poor nutritional quality, displacement of healthier foods, industrial processing and broader lifestyle factors. The research cannot determine exactly how much each factor contributes.
Association Does Not Prove Causation
The review does not show that eating one packaged snack will cause a heart attack.
It compares long-term patterns across large populations. People in the highest intake groups consistently experienced more cardiovascular problems, but they were not randomly assigned to ultra-processed or minimally processed diets.
Randomized trials lasting many years would provide stronger evidence of cause and effect, but such studies are difficult and expensive to conduct for major cardiovascular outcomes.
An umbrella review published in The BMJ found that higher ultra-processed food exposure was associated with multiple adverse outcomes, particularly cardiometabolic disease and mortality. However, much of the pooled evidence was rated as low or very low certainty, emphasizing the need for stronger research.
The full umbrella review can be read through The BMJ.
How to Identify Ultra-Processed Products
A long ingredient list is not automatically proof that a product is unhealthy, but it can provide useful clues.
Ingredients such as artificial flavors, colors, emulsifiers, sweeteners, modified starches, hydrogenated oils and multiple protein isolates may indicate extensive industrial formulation.
Consumers should also examine the nutrition label. Sodium, added sugar, saturated fat, fiber and portion size may be more useful for comparing two products than the processing label alone.
A packaged food with meaningful fiber, moderate sodium and little added sugar may be a better choice than another ultra-processed product loaded with sugar and refined starch.
Small Changes Can Reduce Dependence on Ultra-Processed Food
Reducing ultra-processed food does not require preparing every meal from raw ingredients.
Someone who drinks sugary soda daily might replace some servings with water or unsweetened drinks. Processed breakfast meat can be eaten less often, while eggs, oats, fruit or plain yogurt can take a larger role.
Beans, frozen vegetables, canned fish, plain nuts and minimally processed whole grains can provide convenient alternatives without requiring lengthy cooking.
The goal should be improving the overall dietary pattern rather than becoming anxious about an occasional packaged food.
Heart-Healthy Foods Still Matter Most
The strongest approach is to build meals around vegetables, fruit, whole grains, legumes, nuts, seeds and suitable sources of protein.
These foods can provide fiber, potassium, healthy fats and other nutrients associated with better blood pressure, cholesterol and metabolic health.
Replacing matters as much as removing. Cutting out a processed snack offers little benefit when it is replaced with another food containing similar amounts of sodium, sugar and saturated fat.
Dietary changes are more likely to last when they remain affordable, practical and compatible with a person’s culture and daily routine.
What People With Heart Conditions Should Know
Anyone with cardiovascular disease, high blood pressure, high cholesterol or diabetes may benefit from discussing their diet with a qualified clinician or registered dietitian.
Patients should not replace prescribed medication with dietary changes unless their healthcare professional adjusts the treatment plan.
People with kidney disease, heart failure or other conditions may also require personalized limits on sodium, potassium or fluid intake. General advice about eating more whole foods may need modification in those situations.
The Main Message From the Review
The findings do not establish that every ultra-processed product is equally dangerous. They do show that diets containing the greatest overall quantities are consistently associated with poorer cardiovascular outcomes.
Sugary drinks and processed meats appear to be among the more concerning categories, while some packaged breads, cereals and dairy foods may have very different nutritional profiles.
For most people, the practical response is not to panic over individual foods. It is to gradually shift the overall balance toward minimally processed foods while reducing products high in added sugar, sodium and refined ingredients.
