European journal of preventive cardiology · 2026
Greenspace visitation and risk of major adverse cardiovascular events: evidence from the Houston methodist cardiovascular learning health system registry.
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Dong Weichuan, Chandra Mouli Sarayu, Shahid Izza, Gullapelli Rakesh, Bose Budhaditya, Zhang Tong, Ardakani Jad, Nicolas Juan C, Javed Zulqarnain, Zhang Kai, Chen Zhuo, Rajagopalan Sanjay, Maddock Jay, Nasir Khurram, Al-Kindi Sadeer
Аннотация
AIMS: To evaluate whether mobility-derived greenspace visitation, as a behavioural measure of environmental exposure, is associated with major adverse cardiovascular events (MACE) independent of individual and neighbourhood factors.
METHODS AND RESULTS: We conducted a retrospective cohort study of adults in the Houston Methodist Cardiovascular Disease Learning Health System Registry (2016-2023). Greenspace visitation was defined at the census-tract level using mobility-derived foot-traffic data and modelled as annual visits per resident device. The primary outcome was incident MACE (myocardial infarction, stroke, coronary revascularization, and all-cause mortality). The Cox models, restricted cubic splines, and Kaplan-Meier curves assessed associations with sequential adjustment for demographics, comorbidities, smoking, and neighbourhood social vulnerability. Among 1 088 866 adults without baseline atherosclerotic cardiovascular disease, median (SD) age was 49 (17.6) years, and 59.9% were female. Greenspace visitation varied across neighbourhoods and by demographic and socioeconomic characteristics. Each additional 10 annual visits was associated with lower MACE risk in unadjusted models [hazard ratio (HR) 0.82; 95% confidence interval (CI): 0.81-0.83] and after adjustment for demographics, comorbidities, and smoking (HR 0.89; 95% CI: 0.88-0.91). A non-linear relationship showed risk reductions at low-to-moderate visitation, plateauing at 10-15 visits annually. After adjusting for social vulnerability, associations were attenuated and no longer significant. The Kaplan-Meier curves showed higher event-free survival in high-visitation areas, consistent across MACE components.
CONCLUSION: Mobility-derived greenspace visitation is associated with lower cardiovascular risk. These findings highlight greenspace engagement as a potentially modifiable behavioural exposure and support strategies to enhance access and utilization of greenspaces for cardiovascular prevention.
METHODS AND RESULTS: We conducted a retrospective cohort study of adults in the Houston Methodist Cardiovascular Disease Learning Health System Registry (2016-2023). Greenspace visitation was defined at the census-tract level using mobility-derived foot-traffic data and modelled as annual visits per resident device. The primary outcome was incident MACE (myocardial infarction, stroke, coronary revascularization, and all-cause mortality). The Cox models, restricted cubic splines, and Kaplan-Meier curves assessed associations with sequential adjustment for demographics, comorbidities, smoking, and neighbourhood social vulnerability. Among 1 088 866 adults without baseline atherosclerotic cardiovascular disease, median (SD) age was 49 (17.6) years, and 59.9% were female. Greenspace visitation varied across neighbourhoods and by demographic and socioeconomic characteristics. Each additional 10 annual visits was associated with lower MACE risk in unadjusted models [hazard ratio (HR) 0.82; 95% confidence interval (CI): 0.81-0.83] and after adjustment for demographics, comorbidities, and smoking (HR 0.89; 95% CI: 0.88-0.91). A non-linear relationship showed risk reductions at low-to-moderate visitation, plateauing at 10-15 visits annually. After adjusting for social vulnerability, associations were attenuated and no longer significant. The Kaplan-Meier curves showed higher event-free survival in high-visitation areas, consistent across MACE components.
CONCLUSION: Mobility-derived greenspace visitation is associated with lower cardiovascular risk. These findings highlight greenspace engagement as a potentially modifiable behavioural exposure and support strategies to enhance access and utilization of greenspaces for cardiovascular prevention.