Associations between residential greenness and the predicted 10-year risk for atherosclerosis cardiovascular disease among Chinese adults

Wanqi Yu; Zhu Liu; Yang La; Chuanteng Feng; Bing Yu; Qinjian Wang; Meijing Liu; Zhifeng Li; Yuemei Feng; Laba Ciren; Qibing Zeng; Junmin Zhou; Xing Zhao; Peng Jia; Shujuan Yang

doi:10.1016/j.scitotenv.2023.161643

Associations between residential greenness and the predicted 10-year risk for atherosclerosis cardiovascular disease among Chinese adults

Sci Total Environ. 2023 Apr 10:868:161643. doi: 10.1016/j.scitotenv.2023.161643. Epub 2023 Jan 16.

Authors

Wanqi Yu¹, Zhu Liu², Yang La³, Chuanteng Feng⁴, Bing Yu⁴, Qinjian Wang¹, Meijing Liu¹, Zhifeng Li⁵, Yuemei Feng⁶, Laba Ciren⁷, Qibing Zeng⁸, Junmin Zhou¹, Xing Zhao¹, Peng Jia⁹, Shujuan Yang¹⁰

Affiliations

¹ West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
² Chengdu Center for Disease Control and Prevention, Chengdu, China.
³ School of Medicine, Tibet University, Tibet, China.
⁴ West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Institute for Disaster Management and Reconstruction, Sichuan University-The Hongkong Polytechnic University, Chengdu, China.
⁵ Chongqing Center for Disease Control and Prevention, Chongqing, China.
⁶ School of Public Health, Kunming Medical University, Kunming, China.
⁷ Tibet Center for Disease Control and Prevention, Tibet, China.
⁸ School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China.
⁹ School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; Hubei Luojia Laboratory, Wuhan, China; School of Public Health, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China. Electronic address: jiapengff@hotmail.com.
¹⁰ West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China. Electronic address: rekiny@126.com.

PMID: 36657685
DOI: 10.1016/j.scitotenv.2023.161643

Abstract

Background: Exposure to build environments, especially residential greenness, offers benefits to reduce the development of atherosclerotic cardiovascular diseases (ASCVD). The 10-year ASCVD risk is a useful indicator for long-term ASCVD risk, but the evidence on the association and potential pathway of residential greenness in mitigating its development remains unclear.

Objectives: This study aimed to investigate the associations between residential greenness and the 10-year predicted ASCVD risks, and potentially mediation effect on this association by air pollution, body mass index (BMI) and physical activity (PA).

Methods: The baseline of the China Multi-Ethnic Cohort (CMEC) study, enrolling 99,556 adults during 2018-2019, was used in this cross-sectional study. The participants' 10-year ASCVD risks were predicted as low-, moderate-, and high-risk groups, based on the six risk factors: age, smoking, hypertension, low-density lipoprotein cholesterol (LDL-C), high high-density lipoprotein cholesterol (HDL-C), and high total cholesterol (TC). The 3-year mean value within the circular buffer of 500 m and 1000 m of Enhanced Vegetation Index (EVI_500m and EVI_1000m) were used to assess greenness exposure. Multiple logistic regression was used to evaluate the association between residential greenness and the 10-year ASCVD risks. Stratified analyses by sex, age and smoking status were performed to identify susceptible populations. Causal mediation analysis was used to explore the mediation effects of air pollution, BMI and PA.

Results: A total of 75,975 participants were included, of which 17.9 % (n = 13,614) and 5.6 % (n = 4253) had the moderate and high 10-year ASCVD risks, respectively. Compared to the low-risk group, each interquartile increase in EVI_500m and EVI_1000m reduced the ASCVD risk of the moderate-risk group by 4 % (OR = 0.96 [0.94, 0.98]) and 4 % (OR = 0.96 [0.94, 0.98]), respectively; and reduced the risk of the high-risk group by 8 % (OR = 0.92 [0.90, 0.96]) and 7 % (OR = 0.93 [0.90, 0.97]), respectively. However, the increased greenness did not affect the ASCVD risk of the high-risk group when compared to the moderate-risk group. Effects of residential greenness on the ASCVD risk were stronger in women than in men (p < 0.05), and were not observed in those aged ≥55. PA and BMI partially mediated the association between greenness and the 10-year ASCVD risk.

Conclusions: ASCVD prevention strategies should be tailored to maximize the effectiveness within the groups with different ASCVD risks, better at early stages when the ASCVD risk is low.

Keywords: ASCVD; Cardiovascular disease; EVI; Greenness; Mediation analysis; NDVI; Spatial epidemiology.

MeSH terms

Adult
Air Pollution* / analysis
Cardiovascular Diseases* / prevention & control
China
Cholesterol
Cross-Sectional Studies
East Asian People
Female
Humans
Male
Parks, Recreational
Residence Characteristics*

Substances

Cholesterol