Interplay Between Residential Nature Exposure and Walkability and Their Association with Cardiovascular Health

Omar M. Makram, Nwabunie Nwana, Alan Pan, Juan C. Nicolas, Rakesh Gullapelli, Budhaditya Bose, Ashutosh Sabharwal, Jenny C. Chang, Zulqarnain Javed, Bita A. Kash, Jay E. Maddock, Khurram Nasir, Sadeer Al-Kindi

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Green space has been linked with cardiovascular (CV) health. Nature access and quality may have significant impact on CV risk factors and health.

OBJECTIVES: The authors aimed to investigate the relationship between NatureScore, a composite score for natural environment exposure and quality of green spaces, with CV risk factors and atherosclerotic cardiovascular diseases (ASCVD).

METHODS: A cross-sectional study including one million adult patients from the Houston Methodist Learning Health System Outpatient Registry (2016-2022). NatureScore is a composite measure of natural environment exposure and quality (0-100) calculated for each patient based on residential address. NatureScores was divided into 4 categories: nature deficient/light (0-39), nature adequate (40-59), nature rich (60-79), and nature utopia (80-100). CV risk factors included hypertension, diabetes, dyslipidemia, and obesity.

RESULTS: Among 1.07 million included patients (mean age 52 years, female 59%, Hispanic 16%, Non-Hispanic Black 14%), median NatureScore was 69.4. After adjusting for neighborhood walkability, patients living in highest NatureScore neighborhoods had lower prevalence of CV risk factors (OR: 0.91, 95% CI: 0.90-0.93) and ASCVD (OR: 0.96, 95% CI: 0.93-0.98) than those in lowest NatureScore neighborhoods. A significant interaction existed between NatureScore and Walkability ( P < 0.001), where those in high NatureScore (≥60) high walkability (≥40) areas had lower prevalence of CV risk factors (OR: 0.93, 95% CI: 0.90-0.97, P < 0.001) and were more likely to have optimal CV risk profile (relative risk ratio: 1.09, 95% CI: 1.04-1.14, P = 0.001).

CONCLUSIONS: These findings suggest that while green spaces benefit health, their accessibility through walkable environments is crucial for cardiovascular disease protection.

Original languageEnglish (US)
Article number101457
Pages (from-to)101457
JournalJACC: Advances
Volume4
Issue number1
DOIs
StatePublished - Jan 2025

Keywords

  • cardiovascular
  • diabetes
  • hypertension
  • nature
  • walkability

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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