Volatility in income is associated with an increased risk of cardiovascular disease (CVD) and higher all-cause mortality, according to data from the Coronary Artery Risk Development in Young Adults Study. This ongoing, prospective cohort study is being conducted in four cities in the USA: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota and Oakland, California. Income volatility (defined as the intra-individual s.d. of the percentage change in income across five assessments from 1990 to 2005) was associated with increased risk of CVD (HR 2.07, 95% CI 1.10–3.90) and all-cause mortality (HR 1.78, 95% CI 1.03–3.09). Similarly, a greater number of income drops (defined as a decrease of ≥25% from the previous visit and less than the participant’s average income from 1990 to 2005) was also associated with increased risk of CVD (HR 2.54, 95% CI 1.24–5.19) and all-cause mortality (HR 1.92, 95% CI 1.07–3.44). “The findings of this study reinforce the urgency and growing public health threat associated with income volatility in the United States,” conclude the investigators.