Living in an area with little access to fresh and nutritious foods has been linked to high heart disease risk, but a new study suggests that it’s the inability to afford a healthy diet, rather than access, that’s to blame.

Researchers studied Atlanta residents and found that people living in “food deserts,” where there are few places to buy fresh produce and other healthy foods, had more heart risk factors like hardened arteries and inflammation than people with easy access to healthy foods.

But within food-desert neighborhoods, people with high personal income had fewer heart risk factors than those with low incomes, suggesting it’s money, not access, that prevents some people from having a healthy diet that would lower their heart risk, the study team concludes in Circulation: Cardiovascular Quality and Outcomes.

“Food deserts are defined as areas that have below average income together with poor access to healthy foods, ie. lack of grocery stores (within 1 mile in urban and 10 miles in rural communities),” lead author Dr. Arshed Quyyumi told Reuters Health in an email.

“We found that area income, and even more importantly, personal income was associated with higher cardiovascular risk, and that access to food was not that important a risk,” said Quyyumi, a cardiologist at Emory University School of Medicine in Atlanta.

Researchers have known that neighborhood factors are important social determinants of disease outcomes, he added.

For the study, Quyyumi and his colleagues examined data on more than 1,400 adults, averaging about 50 years old, and living in the Atlanta metropolitan area. Just under 40 percent were men and about 37 percent were African American.

The researchers collected personal and economic information and performed tests to detect signs of inflammation, elevated blood sugar and blood pressure, as well as arterial stiffness.

About 13 percent of participants lived in areas considered food deserts. These people also had higher rates of smoking, were more likely to have high blood pressure and hardened arteries and to be overweight or obese, compared to those not living in food deserts.

When the study team took average neighborhood income and individual incomes into consideration, they found that people living in food deserts in low-income areas had about the same risk of heart disease as their peers living in low-income areas with good food access.

Meanwhile, high-income individuals in low-income neighborhoods had fewer cardiovascular risk factors compared to their lower-income neighbors, and that was true even when they lived in food deserts.

“People not having access to healthy food choices is a possible cause for poor health. However, our study shows the greater impact of lower socio-economic status as a stronger risk factor,” Quyyumi said.

The study team was partly surprised to find so little impact from food access, he said, but speculated that distances might be more important in rural areas. Because this study was in an urban setting, it’s not surprising that income was an important player, he added.

Racial disadvantages are particularly important to highlight, said Dr. Keith Ferdinand, a cardiologist at Tulane University School of Medicine in New Orleans, who co-wrote an editorial accompanying the study.

“African Americans have higher rates of hypertension, stroke, heart attack deaths and heart failure than other groups in the U.S.,” Ferdinand told Reuters Health in an email. Those racial disparities are caused by multiple factors, he added.

“Food deserts may contribute to higher heart disease and strokes, with many black neighborhoods reportedly having more fast food restaurants, fewer supermarkets with healthy options, and there being less availability of safe places for outdoor physical activity,” he said.

Although there is no one best diet for reducing heart disease risk, Ferdinand said, he recommends a Mediterranean-style dietary pattern, which is high in fresh fruits and vegetables, whole grains, fatty fish, low in red meat and lower-fat or fat-free dairy products.

"For many lower socio-economic status communities, these foods are absent, rarely found or extremely expensive," he said.