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

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dc.citation.articleNumber101457en_US
dc.citation.issueNumber1en_US
dc.citation.journalTitleJACC: Advancesen_US
dc.citation.volumeNumber4en_US
dc.contributor.authorMakram, Omar M.en_US
dc.contributor.authorNwana, Nwabunieen_US
dc.contributor.authorPan, Alanen_US
dc.contributor.authorNicolas, Juan C.en_US
dc.contributor.authorGullapelli, Rakeshen_US
dc.contributor.authorBose, Budhadityaen_US
dc.contributor.authorSabharwal, Ashutoshen_US
dc.contributor.authorChang, Jennyen_US
dc.contributor.authorJaved, Zulqarnainen_US
dc.contributor.authorKash, Bitaen_US
dc.contributor.authorMaddock, Jay E.en_US
dc.contributor.authorNasir, Khurramen_US
dc.contributor.authorAl-Kindi, Sadeeren_US
dc.date.accessioned2025-01-09T20:16:56Zen_US
dc.date.available2025-01-09T20:16:56Zen_US
dc.date.issued2025en_US
dc.description.abstractBackground 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.en_US
dc.identifier.citationMakram, O. M., Nwana, N., Pan, A., Nicolas, J. C., Gullapelli, R., Bose, B., Sabharwal, A., Chang, J., Javed, Z., Kash, B., Maddock, J. E., Nasir, K., & Al-Kindi, S. (2025). Interplay Between Residential Nature Exposure and Walkability and Their Association with Cardiovascular Health. JACC: Advances, 4(1), 101457. https://doi.org/10.1016/j.jacadv.2024.101457en_US
dc.identifier.digital1-s2-0-S2772963X24007373-mainen_US
dc.identifier.doihttps://doi.org/10.1016/j.jacadv.2024.101457en_US
dc.identifier.urihttps://hdl.handle.net/1911/118093en_US
dc.language.isoengen_US
dc.publisherElsevieren_US
dc.rightsExcept where otherwise noted, this work is licensed under a Creative Commons Attribution (CC BY) license. Permission to reuse, publish, or reproduce the work beyond the terms of the license or beyond the bounds of fair use or other exemptions to copyright law must be obtained from the copyright holder.en_US
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en_US
dc.subject.keywordcardiovascularen_US
dc.subject.keyworddiabetesen_US
dc.subject.keywordhypertensionen_US
dc.subject.keywordnatureen_US
dc.subject.keywordwalkabilityen_US
dc.titleInterplay Between Residential Nature Exposure and Walkability and Their Association with Cardiovascular Healthen_US
dc.typeJournal articleen_US
dc.type.dcmiTexten_US
dc.type.publicationpublisher versionen_US
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