Relationships between Urban Environments and Crdiovascular Disease Risk

Background Cardiovascular disease (CVD) remains one of the leading causes of mortality and morbidity globally. An environmental approach to increasing physical activity, by creating walkable neighbourhoods where individuals can accumulate active minutes by walking to work, local stores, and appointments may have more success in sustainably increasing activity than traditional exercise programs. Further evaluation is needed to understand the potential benefits of walkable neighbourhood environments in reducing CVD risk to inform its role as a target for public health policy. Methods Results Data were drawn from the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort, derived from health administrative databases. The population studied were community-dwelling, working-age adults. The first study examined cross-sectional associations between neighbourhood walkability and predicted CVD risk. High neighbourhood walkability was associated with a lower predicted 10-year risk of CVD but a higher odds of smoking. The second cross-sectional study focused on interactions between neighbourhood walkability and traffic-related air pollution and their association with hypertension and diabetes. Significant interactions were identified; while high walkability was associated with a lower odds of hypertension and diabetes at low levels of pollution, these exposures were no longer protective in highly polluted areas. The third study explored associations between walkability and the occurrence of major adverse cardiovascular events (MACE) using a retrospective cohort study design. Over a median follow-up of 5 years, adults residing in a highly walkable neighbourhood had a lower rate of MACE, but a higher rate of cardiovascular death than individuals residing in less walkable areas. Subgroup analyses suggested that the increased mortality observed in highly walkable neighborhoods was limited to individuals with psychiatric comorbidities. Conclusions The results of this dissertation suggest that adults who reside in highly walkable neighbourhoods have fewer CVD risk factors and a lower likelihood of experiencing a major cardiovascular event.Ph.D.2021-07-21 00:00:0