The obesogenic environment and incident cardiovascular disease in The Maastricht Study

BACKGROUND: The built environment has been identified as an upstream determinant of cardiovascular disease (CVD) in which neighborhood walkability and healthy food environments may promote increased physical activity and healthier dietary intake. Our aim is to determine if these neighborhood environments are associated with decreased incidence. METHODS: Data from 6,563 participants of The Maastricht Study and Geoscience and Health Cohort Consortium between the ages of 40-75 without history of CVD were analyzed. Objective walkability was measured by the 7-component Dutch Walkability Index while the food environment was an aggregate score of available food outlets, within 1000m Euclidian buffers around residential addresses of participants. Perceived walkability was obtained from the Abbreviated Neighborhood Environment Walkability Scale. Incident CVD was obtained from a follow-up questionnaire. A Cox regression analysis was performed with CVD morbidity time to event outcomes adjusting for demographic and socioeconomic covariates. RESULTS: Over a median follow-up of 7.2 years (1.0-12.0 years), 975 cases were reported. The most walkable neighborhoods were not associated with incident CVD for both perceived (HR: .80; 95% CI = .64, 1.00) and objective (HR: 1.14; 95% CI = .91, 1.43) neighborhood environment measures compared to those living in the least walkable neighborhoods. When considering individual CVD conditions, participants had statistically significant lower incidence of peripheral vascular disease in the highest perceived walkable neighborhoods (HR: .57; 95% CI = .41, .78). The healthiest food environments (HR: .84; 95% CI = .66, 1.06) were not related to incident CVD. CONCLUSIONS: Objectively measured walkability and neighborhood food environment were not associated with overall incident CVD with participants in our study. We found perceived neighborhood walkability to be associated with lower incident peripheral vascular disease. KEY MESSAGES: • Research on the obesogenic environment should additionally be carried out in other regions to gain additional understanding of its effect on cardiovascular disease. • Further study on the impact of walkable environments on individuals with peripheral vascular disease should be considered to understand its effect with this population.