A new review links ultra-processed foods and their additives to higher cardiovascular risk, pointing to large human studies and inflammation-related mechanisms that may help explain why heavily processed diets can harm heart health.

Key takeaways

Higher intake of ultra-processed foods was associated with a higher risk of cardiovascular disease.

Food additives may also contribute to cardiovascular harm, suggesting the issue is not only the overall nutritional profile of ultra-processed foods.

Inflammation, oxidative stress, and disruption of the gut microbiome are among the main proposed mechanisms linking ultra-processed foods to cardiovascular risk.

Cutting back on ultra-processed foods may be a useful step toward supporting cardiovascular health.

Review: Processed Foods and Food Dyes: What Are We Eating and What Is the Cardiovascular Risk? Image Credit: beauty-box / Shutterstock

Review: Processed Foods and Food Dyes: What Are We Eating and What Is the Cardiovascular Risk? Image Credit: beauty-box / Shutterstock

A recent review published in the journal Cardiology in Review has summarized accumulating evidence linking UPFs to CVD, drawing on large-scale cohort and meta-analytic data. These industrial formulations, high in additives, sugar, fat, and salt, are associated with increased risks of CVD, stroke, and cardiovascular mortality, with several cohort studies and meta-analyses supporting a dose-response relationship.

Dietary Impact on Global Cardiovascular Health

The review also highlights proposed mechanisms, including gut microbiome disruption, chronic inflammation driven by NF-κB activation, and oxidative stress linked to specific additives. Reducing UPF intake may therefore represent a modifiable strategy for cardiovascular prevention and population health.

Cardiovascular diseases place a considerable burden on individuals and healthcare systems worldwide. These diseases reduce quality of life and drive long-term economic strain through rising treatment costs.

In this context, diet has emerged as a key modifiable risk factor, with growing evidence highlighting the role of processed foods in disease development. UPFs, typically industrial formulations high in additives and low in whole food content, are increasingly linked to adverse cardiometabolic outcomes. 

Reducing UPF intake offers a potentially simple, practical dietary strategy that individuals can adopt to support cardiovascular health and lower disease risk.

In this review, the authors examined epidemiological evidence and biological mechanisms linking UPF intake to CVD risk.

Inflammatory Pathways and NF-κB Activation

Emerging evidence suggests that UPF additives may increase CVD risk through interconnected inflammatory and oxidative pathways. Preservatives, emulsifiers, and synthetic colorants can disrupt gut microbial balance by reducing beneficial bacteria while promoting pro-inflammatory species. This dysbiosis can impair barrier integrity, promote endotoxemia, and trigger systemic immune activation.

A key mechanism is NF-κB activation, a central regulator of inflammatory gene expression. Once activated, NF-κB drives the release of inflammatory cytokines, including IL-6 and TNF-α, sustaining chronic inflammation. These inflammatory actions promote endothelial dysfunction, enhance monocyte adhesion, and accelerate early atherogenesis.

Oxidative Stress and Vascular Damage Mechanisms

Oxidative stress further amplifies these effects. ROS generated in response to certain additives reinforce NF-κB signaling, creating a self-perpetuating cycle of inflammation and vascular injury.

Over time, this cascade contributes to plaque formation, which increases the risk of hypertension, thrombosis, and progressive CVD. Evidence from both adolescent and adult populations links higher UPF intake to elevated C-reactive protein (CRP) levels and NF-κB-related biomarkers.

Metabolic Effects and Additive-Driven Risks

Beyond inflammation, observational studies associate high intake of UPF additives with obesity, diabetes, and other cardiometabolic outcomes. Compounds such as nitrates, synthetic dyes, and antioxidant preservatives may further contribute through oxidative stress, gut dysbiosis, and endothelial dysfunction. Collectively, these pathways converge on NF-κB-driven inflammation, positioning these additives as plausible contributors to long-term cardiovascular risk.

Cohort Studies Linking UPFs to Cardiovascular Disease

Large prospective cohort investigations consistently show a positive link between UPF consumption and CVD risk. In the NutriNet-Santé cohort in France, comprising over 105,000 participants, a 10% increase in energy intake from UPFs was associated with a 12% higher risk of CVD events [hazard ratio (HR), 1.12]. The associations remained significant after adjustment for key confounders, including sex, age, body mass index (BMI), and physical activity.

Researchers have observed similar patterns across other populations. Data from the Framingham Heart Study Offspring cohort showed that each additional serving of UPF per day was associated with higher risks of cardiovascular events, coronary heart disease (CHD), and CVD-related mortality (HR, 1.07-1.09), regardless of diet quality.

Pooled analyses from major United States (US) cohorts, including participants of the Health Professionals Follow-Up Study (HPFS) and Nurses’ Health Studies (NHS), further support these findings. Participants in the topmost UPF intake quintile demonstrated increased CVD and CHD risks by 11% and 16%, respectively, compared to those in the lowermost quintile.

Meta-Analysis and Dose-Response Evidence

Meta-analytic evidence reinforces this association and supports a dose-response relationship. A recent systematic review, including 22 prospective studies and over a million participants, reported that UPF consumption was linked to a 17% greater risk of CVD. A 10% rise in energy intake from UPFs was associated with a roughly 1.6% to 2.2% increase in CVD-related events, along with increased risks of cardiovascular mortality and stroke.

Role of Additives and Non-Nutritional Factors

Importantly, these links persisted even after adjusting for overall nutrient profiles, suggesting that non-nutritional factors may contribute. Among NutriNet-Santé study participants, higher consumption of emulsifiers, including carboxymethylcellulose, trisodium phosphate, and fatty acid-derived glycerol esters, was associated with an increased risk of CVD events (HRs, 1.03-1.07).

Emerging evidence also links artificial sweeteners to cardiovascular risk through metabolic and microbiome-related effects, although the review notes that direct prospective evidence on cardiovascular events remains limited.

Dietary Recommendations and Public Health Implications

Overall, evidence consistently links high consumption of ultra-processed foods with increased cardiovascular disease risk, supported by epidemiological studies and NF-κB-driven inflammatory mechanisms.

Additives such as preservatives, colorants, and sweeteners may further exacerbate risk through gut dysbiosis and oxidative stress. These findings highlight the importance of shifting toward minimally processed diets to support cardiovascular health.

Journal reference:

Kaiser, M. E., Parikh, M. A., Turitto, G., Grutman, G., Frishman, W. H., and Peterson, S. J. (2026). Processed Foods and Food Dyes: What Are We Eating and What Is the Cardiovascular Risk? Cardiology in Review. DOI: 10.1097/CRD.0000000000001256, https://journals.lww.com/cardiologyinreview/fulltext/9900/processed_foods_and_food_dyes__what_are_we_eating.789.aspx