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Neighborhood walkability correlates to CVD risk, smoking prevalence
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Individuals living in less walkable urban areas have a higher 10-year risk for CVD than those living in highly walkable settings, according to findings published in the Journal of the American Heart Association.
By differentiating neighborhood walkability using quintiles (Q) based on population density, dwelling density, street connectivity and number of accessible destinations like banks, grocery stores and restaurants, researchers found that adults living in less walkable areas have greater risk for 10-year CVD than those living in the most walkable areas (least [Q1] vs. most [Q5]: OR = 1.09; 95% CI, 0.98-1.22).
“The findings demonstrate that walkability is associated with clinically relevant differences in cardiovascular disease risk,” Nicholas Howell, PhD, of the Institute for Health Policy, Management and Evaluation at the University of Toronto, said in a press release. “From a public policy perspective, the findings support the idea that the benefits of walkable neighborhoods could be significant enough to move the dial for individual health.”
Moreover, the greatest drop in 10-year CVD risk was observed between Q3 and Q5 (OR = 1.33; 95% CI, 1.23-1.45). However, these patterns were not consistent for other outcomes including systolic BP, total and HDL cholesterol levels and prior diabetes diagnosis.
“This research demonstrates that a future cardiovascular risk can be predicted based on the walkability of your residence,” Gillian Booth, MD, MSc, senior adjunct scientist at Li Ka Shing Knowledge Institute, said the press release. “This research should be an encouragement for those living in less walkable neighborhoods to source physical activities in other ways.”
Walkability, smoking and CVD
In other findings, researchers observed a nonlinear association between CVD risk and smoking prevalence in walkable neighborhoods:
- Q1 (nonsmoking OR = 1.18; 95% CI, 1.06-1.32; vs. smoking OR = 1.09; 95% CI, 0.84-1.41);
- Q2 (nonsmoking OR = 1.42; 95% CI, 1.29-1.58; vs. smoking OR = 1.17; 95% CI, 0.94-1.46);
- Q3 (nonsmoking OR = 1.39; 95% CI, 1.26-1.54; vs. smoking OR = 1.4; 95% CI, 1.19-1.65); and
- Q4 (nonsmoking OR = 1.28; 95% CI, 1.18-1.4; vs. smoking OR = 1.19; 95% CI, 1.03-1.37).
“We identified different patterns in association between walkability and smoking behavior vs. walkability and other cardiovascular risk factors, whereby exposure to a less walkable neighborhood was associated with a lower likelihood of being a smoker,” the researchers wrote. “This difference likely contributed towards the observed nonlinearity in association between walkability and overall cardiovascular disease risk. However, the nonlinearity in the primary outcome persisted in analyses stratified by individuals’ smoking status. It is not immediately clear what may be causing these patterns of point-estimates.”
Design and future research
Using data from the CANHEART cohort, researchers analyzed 44,448 adults aged 50 to 59 years living in a major urban center in Ontario, Canada, to determine whether neighborhood walkability is a risk factor for future CVD. According to the study, the primary outcome was a predicted 10-year CVD risk of at least 7.5%, the recommended threshold for statin use, as specified by the American College of Cardiology/American Heart Association Pooled Cohort Equation.
“Future research is needed to confirm these findings using longitudinal designs, and to understand the underlying causes of the association between walkability and smoking,” the researchers wrote. “Our findings emphasize the importance of considering the health implications of urban design changes holistically. In particular, strategies to help curb smoking rates in highly walkable areas may help improve the public health impact of urban design improvements.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.
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