Foods of concern, cardiopreventive medication use and risk of cardiovascular diseases: a prospective study in the CARTaGENE cohort

BACKGROUND: In Canada, by 2026, prepackaged foods high in saturated fat, sodium, or sugar require a front-of-package warning symbol (FOPS). However, evidence on ultraprocessed foods (UPFs) raises concerns about whether this approach fully captures all foods of concern-particularly for individuals with hypertension or hypercholesterolemia, for whom dietary changes are crucial. It is also important to assess whether medication use diminishes the benefits of limiting such foods. OBJECTIVES: We examined the joint association of consuming foods of concern-defined as UPFs or foods with FOPS-medication use, and cardiovascular disease (CVD) risk in adults with hypertension and/or hypercholesterolemia from the CARTaGENE cohort. METHODS: This prospective cohort study included 2123 participants free of CVD but with hypertension and/or hypercholesterolemia at baseline (2009-2010). Using food frequency questionnaire (FFQ) data (2012), UPFs were identified using Nova, and foods with FOPS using Health Canada criteria. Cholesterol- and blood pressure-lowering medication use was self-reported. Incident CVDs were identified using administrative databases, from FFQ completion to 31 December, 2021. Associations between intake of foods of concern, medication use, and CVD risk were assessed using multivariable-adjusted Cox proportional hazards models. RESULTS: In multivariable-adjusted analyses-including medication use, energy intake, and BMI-the hazard ratio (HR) for CVD risk associated with a 10% lower difference in UPF consumption-accompanied by a proportional higher difference in non-UPF-was 0.87 [95% confidence interval (CI): 0.78, 0.97]. For foods with FOPS, the corresponding HR was 0.80 (95% CI: 0.70, 0.93), with no evidence that this estimate differed significantly from that for UPF (P = 0.42). There was no evidence of departure from additivity between medication use and the consumption of foods of concern relative to CVD risk. CONCLUSIONS: In individuals with hypertension or hypercholesterolemia, lower consumption of UPFs or foods with FOPS was similarly associated with lower CVD risk, independent of concomitant medication use.