Associations of residential greenness with incident vascular diseases in middle-aged and older adults: A large prospective cohort study.

The relationship between residential greenness and chronic vascular diseases (VD) remains inconclusive. This study aimed to assess the associations between residential greenness and the incidence of new-onset VD. We analyzed data from a cohort of up to 240,000 participants without prior VD. To investigate the associations between residential greenness and the incidence of VD, we employed Cox proportional hazard models alongside restricted cubic spline regression. Greenness encompassed green space, domestic garden, and natural environment, while VD included eight specific conditions, such as heart failure, sequelae of cerebrovascular disease (CeVD), and peripheral vascular disease (PVD). Participants were stratified according to their exposure levels of residential greenness, with the lowest level serving as the reference group. Over a median follow-up of 10.8 years, more than 30,000 participants developed VD. Green space and natural environment were associated with a decreased VD risk, with green space showing the strongest effect on sequelae of CeVD (HR = 0.662, 95 %CI: 0.556-0.789), followed by natural environment on PVD (0.738, 0.667-0.815). In contrast, domestic garden was correlated with an increased VD risk, such as sequelae of CeVD (1.252, 1.079-1.453) and PVD (1.141, 1.050-1.239). Furthermore, stratified analyses revealed that the protective associations of residential greenness were particularly pronounced for heart failure among obesity individuals, males, and those who consume alcohol. Our findings suggest that exposure to green space and natural environment was negatively associated with VD risk. These results may underscore the potential role of residential greenness in regulating VD risk.