Rifas-Shiman Sheryl L, Yi Li, Aris Izzuddin M, Lin Pi-I Debby, Hivert Marie-France, Chavarro Jorge E, Suel Esra, James Peter, Oken Emily
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Biol Sex Differ. 2025 Jul 1;16(1):45. doi: 10.1186/s13293-025-00718-3.
Many women experience suboptimal cardiovascular health (CVH) during midlife. Greenspace exposure has been inversely associated with cardiovascular disease because it may reduce harmful environmental exposures and promote healthy behaviors. Most prior studies used satellite-based rather than ground-level exposures and did not examine overall CVH.
We performed a longitudinal analysis of women in the Project Viva cohort based in Eastern Massachusetts. We applied deep learning algorithms to Google Street View images to derive metrics of visible trees, grass, and other greenspace within 500 m of participant's residential addresses in 2012-2016 (mean age 46 years). About five years later (mean age 51 years), participants completed questionnaires and research measurements including blood collection. We calculated CVH scores using Life's Essential 8 (LE8) construct (0-100 points, higher = better), which includes four behavioral (diet, physical activity, sleep, and avoidance of smoking) and four biomedical measures (body mass index, blood pressure, blood lipids, and blood glucose). We used linear regression models adjusted for age and both individual- and neighborhood-level socioeconomic status.
Among 767 participants, 68% were non-Hispanic White, and 74% were college graduates. Mean (SD) CVH score was 72 (13) points. When including three greenspace components in the same model, higher % trees (per SD) was associated with higher overall CVH score (β = 2.4; 95% CI: 1.3, 3.5), as well as higher behavioral (β = 2.8; 95% CI: 1.4, 4.3) and biomedical (β = 2.8; 95% CI: 1.0, 4.7) sub-scores. Additionally, % other greenspace (per SD) was associated with better biomedical CVH scores (β = 2.2; 95% CI: 0.4, 3.9), whereas associations for % grass were non-significant. Higher % trees (per SD) was associated with higher scores for most individual CVH components, including diet (β = 2.1 points; 95% CI: 0.7, 3.4), physical activity (β = 4.0; 95% CI: 1.2, 6.9), sleep (β = 2.6; 95% CI: 0.9, 4.4), BMI (β = 5.8; 95% CI: 2.8, 8.8), and blood glucose (β = 2.2; 95% CI: 0.3, 4.2).
Greater street-view greenspace exposure, especially visible trees in streetscapes, was associated with better CVH among midlife women. Increasing trees in neighborhoods may be a valuable public health strategy to improve multiple metrics of cardiovascular health.
许多女性在中年时心血管健康状况欠佳。接触绿地与心血管疾病呈负相关，因为它可能减少有害的环境暴露并促进健康行为。大多数先前的研究使用基于卫星的而非地面水平的暴露数据，并且未考察整体心血管健康状况。
我们对马萨诸塞州东部的“活力计划”队列中的女性进行了纵向分析。我们将深度学习算法应用于谷歌街景图像，以得出2012年至2016年（平均年龄46岁）参与者居住地址500米范围内可见树木、草地及其他绿地的指标。大约五年后（平均年龄51岁），参与者完成问卷调查和包括血液采集在内的研究测量。我们使用“生命八大要素”（LE8）构建指标（0 - 100分，分数越高越好）计算心血管健康得分，该指标包括四项行为指标（饮食、身体活动、睡眠和戒烟）和四项生物医学指标（体重指数、血压、血脂和血糖）。我们使用了针对年龄以及个体和社区层面社会经济地位进行调整的线性回归模型。
在767名参与者中，68%为非西班牙裔白人，74%为大学毕业生。心血管健康得分的平均值（标准差）为72（13）分。在同一模型中纳入三个绿地组成部分时，更高的树木占比（每标准差）与更高的整体心血管健康得分相关（β = 2.4；95%置信区间：1.3，3.5），以及更高的行为指标得分（β = 2.8；95%置信区间：1.4，4.3）和生物医学指标得分（β = 2.8；95%置信区间：1.0，4.7）。此外，其他绿地占比（每标准差）与更好的生物医学心血管健康得分相关（β = 2.2；95%置信区间：0.4，3.9），而草地占比的相关性不显著。更高的树木占比（每标准差）与大多数个体心血管健康组成部分的更高得分相关，包括饮食（β = 2.1分；95%置信区间：0.7，3.4）、身体活动（β = 4.0；95%置信区间：1.2，6.9）、睡眠（β = 2.6；95%置信区间：0.9，4.4）、体重指数（β = 5.8；95%置信区间：2.8，8.8）和血糖（β = 2.2；95%置信区间：0.3，4.2）。
更多地接触街景绿地，尤其是街道景观中的可见树木，与中年女性更好的心血管健康状况相关。增加社区内的树木可能是改善心血管健康多项指标的一项有价值的公共卫生策略。
