Green space and stroke: A scoping review of the evidence

Moderating effect of green space on relationship between atmospheric particulate matter and cardiovascular and cerebrovascular disease mortality in Ningxia, China

OBJECTIVE

This study explores the moderating effect of green space on the association between atmospheric particulate matter (PM) and cardiovascular and cerebrovascular disease (CCVD) mortality.

METHODS

Data on CCVD mortality, PM, meteorological factors, and the Normalized Difference Vegetation Index (NDVI) of green spaces in Ningxia from 2010 to 2020 were collected. A time-series generalized additive mixed-effect model (GAMM) was applied to analyze the exposure-response relationship between PM and CCVD mortality. The moderating effect of green spaces was examined using green space buffers of different radii (300 m, 500 m, 1000 m, and 2000 m) and density.

RESULTS

There were 150,356 CCVD deaths in Ningxia during the study period. The annual mean concentrations of PM2.5 and PM10 were 44.44 μg/m³ and 105.30 μg/m³, respectively, with an annual mean NDVI value of 0.25 within a 500 m radius buffer. An increase of 10 μg/m³ in PM2.5 and PM10 concentrations was significantly associated with an elevated risk of CCVD mortality, with the strongest excess risk (ER) observed at lag07 lag. The ER for PM2.5 was 1.43% (95% CI: 0.97%, 1.89%), and for PM10 was 0.55% (95% CI: 0.38%, 0.72%). The interaction analysis indicated that higher green space density could moderate the association between PM exposure and CCVD mortality risk. and as the green space buffer zone expanded, the interaction on CCVD mortality risk progressively strengthened. The independent moderation analysis indicated that an increase in green space buffer zone was associated with a reduced risk, and as green space density increased from Q1 to Q3, the ER for PM2.5-related CCVD mortality decreased from 1.56% to 0.6%, while the ER for PM10-related CCVD mortality decreased from 0.53% to 0.09%. In conclusion, atmospheric PM is associated with increased CCVD mortality risk, while larger green space buffers and higher green space density significantly moderated this association.

Green space is associated with new-onset stroke among Chinese middle-aged and older adults: data from China Health and Retirement Longitudinal Study (CHARLS)

Background and aims

The relationship between green space and new-onset stroke is inconclusive. This study aimed to investigate the association between green space and stroke risk among Chinese middle-aged and older adults.

Methods

Data were taken from participants aged ≥45 years in the China Health and Retirement Longitudinal Study (CHARLS). Baseline data were collected in 2011 and new-onset stroke data were gathered during follow-up in 2013, 2015, 2018, and 2020. Multivariate Cox regression models were constructed to investigate the association between green space and stroke risk. Subgroup analysis was also performed.

Results

A total of 13,696 participants with a mean age of 59.3 ± 9.3 years were included. After a mean follow-up duration of 6.32 years, there were 728 stroke events during a total of 86,530 person-years of follow-up. The study found a L-shaped relationship between green space and the risk of new-onset stroke in participants. By using a two-piecewise linear regression model, we calculated that the inflection point for the per capita park green area was 10.61 square meters per person (log-likelihood ratio test p = 0.041). On the left of the inflection point, we observed a negative relationship between green space and the incidence of stroke (HR: 0.89, 95% CI: 0.84-0.94, p = 0.0001). On the right side of the inflection point, however, the relationship tended to be saturated (HR: 0.97, 95% CI: 0.94-1.01, p = 0.2111).

Conclusion

Our study found that the relationship between green space and the risk of new-onset stroke follows a L-shaped curve. A lower amount of green space is associated with an increased risk of new-onset stroke. These findings require confirmation in future studies.

Association of urban green and blue space with accelerated ageing: A cohort Study in the UK Biobank

OBJECTIVE

We investigated the associations between urban green and blue spaces and the incidence of accelerated ageing, which have rarely been studied.

METHODS

Analyzed UK Biobank data (2006-2010) on 440,785 participants, focusing on urban green and blue space (UGBS). General linear models and logistics models assessed links between UGBS and accelerated ageing (Klemera-Doubal method, telomere length and frailty). Mediation analysis examined the role of pollution and other factors.

RESULTS

After controlling for random effects and various types of covariates, we found that 1) populations with higher levels of UGBS exposure are associated with accelerated ageing and slowing down; 2) UGBS has the greatest impact on accelerated ageing within a 1000-m street network buffer distance; 3) Participants living in heavily polluted areas should pay more attention to UGBS; 4) Intermediary analysis found that UGBS mainly accelerates aging by reducing harm, rather than affecting the population's ability to recover and build.

CONCLUSIONS

UGBS with a composite weighted score showed a better correlation with accelerated ageing than green spaces. Other factors such as gender, race and lifestyle also influence the impact of the environment on accelerated ageing.

Short-term ozone exposure on stroke mortality and mitigation by greenness in rural and urban areas of Shandong Province, China

BACKGROUND

Short-term exposure to ozone (O3) has been associated with higher stroke mortality, but it is unclear whether this association differs between urban and rural areas. The study aimed to compare the association between short-term exposure to O3 and ischaemic and haemorrhagic stroke mortality across rural and urban areas and further investigate the potential impacts of modifiers, such as greenness, on this association.

METHODS

A multi-county time-series analysis was carried out in 19 counties of Shandong Province from 2013 to 2019. First, we employed generalized additive models (GAMs) to assess the effects of O3 on stroke mortality in each county. We performed random-effects meta-analyses to pool estimates to counties and compare differences in rural and urban areas. Furthermore, a meta-regression model was utilized to assess the moderating effects of county-level features.

RESULTS

Short-term O3 exposure was found to be associated with increased mortality for both stroke subtypes. For each 10-µg/m3 (lag0-3) rise in O3, ischaemic stroke mortality rose by 1.472% in rural areas and 1.279% in urban areas. For each 0.1-unit increase in the Enhanced Vegetation Index (EVI) per county, the ischaemic stroke mortality caused by a 10-µg/m3 rise in O3 decreased by 0.60% overall and 1.50% in urban areas.

CONCLUSIONS

Our findings add to the evidence that short-term O3 exposure increases ischaemic and haemorrhagic stroke mortality and has adverse effects in urban and rural areas. However, improving greenness levels may contribute to mitigating the detrimental effects of O3 on ischaemic stroke mortality.

The Effects of Green Spaces and Noise Exposure on the Risk of Ischemic Stroke: A Case-Control Study in Lebanon

BACKGROUND

Environmental surroundings reduce the rate of several diseases, especially those related to stressful events. Ischemic stroke can be affected by such events, either directly or through its risk factors. Therefore, the present study evaluates the effects of green spaces and noise exposure on the risk of ischemic stroke.

METHODS

A case-control study was carried out, including 200 ischemic stroke cases within the first 48 h of diagnosis and 200 controls, divided equally into hospitalized and non-hospitalized participants. Controls were matched to cases based on age and gender. Socio-demographic characteristics were assessed, in addition to environmental surroundings and noise exposure at home and at workplaces.

RESULTS

Living in a house, having a house garden, and taking care of the garden were associated with a lower risk of suffering an ischemic stroke (p < 0.001, p < 0.001, and p = 0.009, respectively). However, having buildings as the view from home led to a higher stroke rate (p < 0.001). Working in an urban area, the workplace being surrounded by buildings, and the workplace not being surrounded by green spaces were also associated with a higher risk of suffering an ischemic stroke (p = 0.002, p = 0.001, and p = 0.03, respectively). As for noise exposure, being exposed to traffic noise, human noise, and other types of noise was significantly associated with a higher risk of ischemic stroke, while being exposed to higher levels of natural noise was significantly associated with a lower risk of ischemic stroke. Higher levels of noise were also associated with higher risks of ischemic stroke in homes and workplaces (p < 0.001 and p = 0.008, respectively).

CONCLUSIONS

Environmental surroundings and noise exposure were found to affect the risk of ischemic stroke. Greater green spaces and lower noise exposure play a protective role against ischemic stroke, suggesting a possible prevention strategy through environmental modifications at home and workplaces.

Greenspaces And Cardiovascular Health

Accumulating evidence suggests that living in areas of high surrounding greenness or even brief exposures to areas of high greenery is conducive to cardiovascular health, which may be related to the environmental, social, psychological, and physiological benefits of greenspaces. Recent data from multiple cross-sectional, longitudinal, and cohort studies suggest that living in areas of high surrounding greenness is associated with a lower risk of all-cause and cardiovascular mortality. High levels of neighborhood greenery have been linked also to a decrease in the burden of cardiovascular disease risk factors as reflected by lower rates of hypertension, dyslipidemia, and diabetes. Those who live in greener environments report better mental health and more frequent social interactions, which can benefit cardiovascular health as well. In this narrative review, we discuss evidence linking greenspaces to cardiovascular health as well as the potential mechanisms underlying the beneficial effects of greenspaces, including the impact of vegetation on air, noise and light pollution, ambient temperature, physical activity, mental health, and biodiversity. We review literature on the beneficial effects of acute and chronic exposure to nature on cardiovascular disease risk factors, inflammation and immune function, and we highlight the potential cardiovascular effects of biogenic volatile organic compounds that are emitted by trees and shrubs. We identify current knowledge gaps in this area and underscore the need for additional population studies to understand more clearly and precisely the link between greenness and health. Such understanding is urgently needed to fully redeem the promise of greenspaces in preventing adverse environmental exposures, mitigating the effects of climate change, and creating healthier living environments.