Residential Greenness and the Incidence of Dyslipidemia in Chinese Adults: A Large Prospective Cohort Study

Dyslipidemia is a significant risk factor for cardiovascular disease. While cross-sectional studies suggest lower odds of dyslipidemia in greener environments, longitudinal research is limited. This prospective cohort study analyzed data from 3,454,623 adults from January 2017 to December 2021, focusing on dyslipidemia and its subtypes. Residential greenness was assessed using vegetation indices and greenspace percentages. Cox regressions and generalized estimating equation models were used to analyze associations between greenness and dyslipidemia outcomes. Over a median follow-up period of 3.21 years, 744,732 cases of dyslipidemia were observed. Greener environments were associated with a reduced risk of dyslipidemia, hypercholesterolemia, hypertriglyceridemia, and hyperbetalipoproteinemia (hazard ratios ranged from 0.82 to 0.96) and an increased risk of hypoalphalipoproteinemia (hazard ratios were 1.12 to 1.15). Higher greenness levels were linked to lower serum lipids. These associations were stronger among older adults and those with higher education. Mediation analyses showed that lower air pollution, temperature, and higher physical activity accounted for 2.08-33.72% of the associations between greenness and dyslipidemia. Our findings suggest that greenspace exposure can be incorporated into dyslipidemia etiology and prevention strategies. Nature therapies like forest bathing can be supplementary strategies.