Interplay Between Residential Nature Exposure and Walkability and Their Association with Cardiovascular Health.

Background: Green space has been linked with cardiovascular (CV) health. Nature access and quality may have significant impact on CV risk factors and health. Objectives: The authors aimed to investigate the relationship between NatureScore, a composite score for natural environment exposure and quality of green spaces, with CV risk factors and atherosclerotic cardiovascular diseases (ASCVD). Methods: A cross-sectional study including one million adult patients from the Houston Methodist Learning Health System Outpatient Registry (2016-2022). NatureScore is a composite measure of natural environment exposure and quality (0-100) calculated for each patient based on residential address. NatureScores was divided into 4 categories: nature deficient/light (0-39), nature adequate (40-59), nature rich (60-79), and nature utopia (80-100). CV risk factors included hypertension, diabetes, dyslipidemia, and obesity. Results: Among 1.07 million included patients (mean age 52 years, female 59%, Hispanic 16%, Non-Hispanic Black 14%), median NatureScore was 69.4. After adjusting for neighborhood walkability, patients living in highest NatureScore neighborhoods had lower prevalence of CV risk factors (OR: 0.91, 95% CI: 0.90-0.93) and ASCVD (OR: 0.96, 95% CI: 0.93-0.98) than those in lowest NatureScore neighborhoods. A significant interaction existed between NatureScore and Walkability ( Conclusions: These findings suggest that while green spaces benefit health, their accessibility through walkable environments is crucial for cardiovascular disease protection.