Less Walkable Neighborhoods Are Associated With Worse Cardiovascular Risk Profile

Introduction: There is mounting evidence that neighborhoods that have low levels of walkability have higher burdens of cardiovascular disease (CVD) risk factors such as obesity and hypertension. However, few studies have examined the impact of walkability on overall cardiovascular risk. Hypothesis: We hypothesized that residents living in less walkable communities have a higher burden of cardiovascular risk factors and a greater predicted risk for future CVD events. Methods: We assembled a cross-sectional sample of community dwelling adults aged 40-74 on January 1, 2008 from the CANHEART cohort. We ascertained systolic blood pressure, HDL and total cholesterol, smoking status, and diabetes status using a combination of EMR, clinical laboratory databases, and health administrative databases. The primary outcome was an estimated total 10-year cardiovascular disease risk of ≥ 7.5% using the ACC/AHA Pooled Cohort risk score. Walkability was measured using a validated index and divided into quintiles from lowest (Q1) to highest (Q5). The associations were tested using linear and logistic regression with cluster-robust standard errors, adjusting for confounders. Results: In total, 44,448 individuals were included in the analysis. Individuals living in less walkable areas had a higher predicted 10-year CVD risk than those living in highly walkable areas. The association was non-linear, as individuals living in neighborhoods of mid-range walkability (Q3) were even more likely to have an estimated 10-year CVD risk exceeding 7.5% in comparison to those in Q5 (OR = 1.33, (1.23, 1.45)). Conversely, we observed monotonic associations between decreasing walkability and higher mean systolic blood pressure (Q1 vs. Q5: +2.73 mmHg, 95% CI: +2.11, + 3.35) and odds of diabetes (Q1 vs. Q5: OR = 1.29, 95% CI: 1.13, 1.47). Dose-response associations were also observed between decreasing walkability and lower HDL cholesterol (Q1 vs. Q5: -1.93 mg/dl, 95% CI: -2.32, -1.16) and likelihood of being a current smoker (Q1 vs. Q5: OR = 0.76, 95% CI: 0.67, 0.85). Conclusions: Residents living in less walkable neighborhoods had a higher burden of CVD risk factors and a higher estimated risk of future CVD. Conversely, the likelihood of smoking was higher in more walkable neighborhoods, suggesting this may be an area to focus smoking cessation efforts.