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J Am Heart Assoc. 2019 Nov 5;8(21):e013146. doi: 10.1161/JAHA.119.013146. Epub 2019 Oct 31.

Association Between Neighborhood Walkability and Predicted 10-Year Cardiovascular Disease Risk: The CANHEART (Cardiovascular Health in Ambulatory Care Research Team) Cohort.

Howell NA1,2,3,4, Tu JV2,5,4,6, Moineddin R7,4, Chu A3,4, Booth GL1,2,5,4.

Author information

1
Centre for Urban Health Solutions Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada.
2
Institute of Health Policy, Management, and Evaluation Dalla Lana School of Public Health University of Toronto Ontario Canada.
3
Faculty of Medicine University of Toronto Ontario Canada.
4
ICES Toronto Ontario Canada.
5
Department of Medicine University of Toronto Ontario Canada.
6
Schulich Heart Centre Sunnybrook Health Sciences Centre Toronto Ontario Canada.
7
Department of Family and Community Medicine Faculty of Medicine University of Toronto Ontario Canada.

Abstract

Background Individuals living in unwalkable neighborhoods appear to be less physically active and more likely to develop obesity, diabetes mellitus, and hypertension. It is unclear whether neighborhood walkability is a risk factor for future cardiovascular disease. Methods and Results We studied residents living in major urban centers in Ontario, Canada on January 1, 2008, using linked electronic medical record and administrative health data from the CANHEART (Cardiovascular Health in Ambulatory Care Research Team) cohort. Walkability was assessed using a validated index based on population and residential density, street connectivity, and the number of walkable destinations in each neighborhood, divided into quintiles (Q). The primary outcome was a predicted 10-year cardiovascular disease risk of ≥7.5% (recommended threshold for statin use) assessed by the American College of Cardiology/American Heart Association Pooled Cohort Equation. Adjusted associations were estimated using logistic regression models. Secondary outcomes included measured systolic blood pressure, total and high-density lipoprotein cholesterol levels, prior diabetes mellitus diagnosis, and current smoking status. In total, 44 448 individuals were included in our analyses. Fully adjusted analyses found a nonlinear relationship between walkability and predicted 10-year cardiovascular disease risk (least [Q1] versus most [Q5] walkable neighborhood: odds ratio =1.09, 95% CI: 0.98, 1.22), with the greatest difference between Q3 and Q5 (odds ratio=1.33, 95% CI: 1.23, 1.45). Dose-response associations were observed for systolic blood pressure, high-density lipoprotein cholesterol, and diabetes mellitus risk, while an inverse association was observed with smoking status. Conclusions In our setting, adults living in less walkable neighborhoods had a higher predicted 10-year cardiovascular disease risk than those living in highly walkable areas.

KEYWORDS:

built environment; cardiovascular disease risk; diabetes mellitus; smoking; walkability

PMID:
31665997
DOI:
10.1161/JAHA.119.013146
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