TY - JOUR
T1 - The built environment and cardiovascular disease
T2 - an umbrella review and meta-meta-analysis
AU - Liu, Mingwei
AU - Meijer, Paul
AU - Lam, Thao Minh
AU - Timmermans, Erik J
AU - Grobbee, Diederick E
AU - Beulens, Joline Wj
AU - Vaartjes, Ilonca
AU - Lakerveld, Jeroen
N1 - Funding Information: M.L. had financial support from China Scholarships Council; all other authors had financial support from NWO Gravitation grant Exposome-NL (Grant/Award Number: 024.004.017). The funders didn’t have any role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. We confirm the independence of researchers from funders and that all authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. Publisher Copyright: © 2023 The Author(s).
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Aims: To provide a comprehensive overview of the current evidence on objectively measured neighbourhood built environment exposures in relation to cardiovascular disease (CVD) events in adults. Methods and results: We searched seven databases for systematic reviews on associations between objectively measured long-term built environmental exposures, covering at least one domain (i.e. outdoor air pollution, food environment, physical activity environment like greenspace and walkability, urbanization, light pollution, residential noise, and ambient temperature), and CVD events in adults. Two authors extracted summary data and assessed the risk of bias independently. Robustness of evidence was rated based on statistical heterogeneity, small-study effect, and excess significance bias. Meta-meta-analyses were conducted to combine the meta-analysis results from reviews with comparable exposure and outcome within each domain. From the 3304 initial hits, 51 systematic reviews were included, covering 5 domains and including 179 pooled estimates. There was strong evidence of the associations between increased air pollutants (especially PM2.5 exposure) and increased residential noise with greater risk of CVD. Highly suggestive evidence was found for an association between increased ambient temperature and greater risk of CVD. Systematic reviews on physical activity environment, food environment, light pollution, and urbanization in relation to CVD were scarce or lacking. Conclusion: Air pollutants, increased noise levels, temperature, and greenspace were associated with CVD outcomes. Standardizing design and exposure assessments may foster the synthesis of evidence. Other crucial research gaps concern the lack of prospective study designs and lack of evidence from low-to-middle-income countries (LMICs).
AB - Aims: To provide a comprehensive overview of the current evidence on objectively measured neighbourhood built environment exposures in relation to cardiovascular disease (CVD) events in adults. Methods and results: We searched seven databases for systematic reviews on associations between objectively measured long-term built environmental exposures, covering at least one domain (i.e. outdoor air pollution, food environment, physical activity environment like greenspace and walkability, urbanization, light pollution, residential noise, and ambient temperature), and CVD events in adults. Two authors extracted summary data and assessed the risk of bias independently. Robustness of evidence was rated based on statistical heterogeneity, small-study effect, and excess significance bias. Meta-meta-analyses were conducted to combine the meta-analysis results from reviews with comparable exposure and outcome within each domain. From the 3304 initial hits, 51 systematic reviews were included, covering 5 domains and including 179 pooled estimates. There was strong evidence of the associations between increased air pollutants (especially PM2.5 exposure) and increased residential noise with greater risk of CVD. Highly suggestive evidence was found for an association between increased ambient temperature and greater risk of CVD. Systematic reviews on physical activity environment, food environment, light pollution, and urbanization in relation to CVD were scarce or lacking. Conclusion: Air pollutants, increased noise levels, temperature, and greenspace were associated with CVD outcomes. Standardizing design and exposure assessments may foster the synthesis of evidence. Other crucial research gaps concern the lack of prospective study designs and lack of evidence from low-to-middle-income countries (LMICs).
KW - Air pollution
KW - Built environment
KW - Cardiovascular disease
KW - Exposome
KW - Noise
KW - Umbrella review
UR - http://www.scopus.com/inward/record.url?scp=85177763010&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/eurjpc/zwad241
DO - https://doi.org/10.1093/eurjpc/zwad241
M3 - Article
C2 - 37486178
SN - 2047-4873
VL - 30
SP - 1801
EP - 1827
JO - European journal of preventive cardiology
JF - European journal of preventive cardiology
IS - 16
ER -