Outdoor living environment and cardiovascular disease risk: results from a Swedish cohort

Abstract Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide. While sociodemographic, dietary and lifestyle factors have been well documented in relation to CVD, environmental factors have been less studied. However, considering the ongoing biodiversity, climate, and health crises, it is imperative to better understand the interplay between the environment and health. This study aimed to examine the associations between green qualities of the residential environment and CVD. The Malmö Diet and Cancer study is a prospective cohort initiated in the 1990s in the city of Malmö (southern Sweden). At baseline, participants were invited to a health screening, including extensive questionnaires about socioeconomic conditions, lifestyle and diet, clinical examination and blood sampling. The residential coordinates of the participants at baseline were linked to the Scania Outdoor Environment Database comprising scores for a range of perceived qualities of the neighbourhood outdoor environment. Three greenness-related dimensions (serene, natural, diverse) were selected for this substudy. Information on incidence of CVD until 2019 was retrieved from Swedish registers. Adjusted Cox proportional hazards models were used to estimate associations between green-related qualities and cardiovascular diseases (major adverse coronary events). Approximately 27000 participants were included, of which 60% were women. The average age at baseline was 58 years old (±8). Mean follow-up was 20 years (±7) and 4318 cases of major adverse coronary events were identified. Preliminary results suggest that several sociodemographic and lifestyle factors, as well as some aspects of neighbourhood greenness, were associated to increased cardiovascular incidence. Neighbourhood greenness might play a role in major adverse coronary events incidence. Further investigation on underlying mechanisms is required. Key messages • Identifying environmental risk factors for cardiovascular disease is of importance for public health. • Neighbourhood greenness might play a role in cardiovascular disease incidence, and underlying mechanisms need to be investigated further.