Do air pollution and neighborhood greenness exposures improve the predicted cardiovascular risk?

Background: Numerous studies show associations between exposure to Particulate Matter and Cardiovascular disease (CVD). Current cardiovascular equations incorporate the major risk factors for CVD. The patients' environment, however, is not incorporated in these equations. Methods: In a retrospective analysis, we assessed the contribution of neighborhood greenness and particulate matter (coarse-PM and PM0.2. The c-statistics slightly improved from 77.30%–77.40% for the prediction of MI (p=0.004) and from 75.60%–75.76% for the prediction of stroke (p=0.027). Calibration was fair in all models. The associations were partially mediated through the patients' comorbidities. Conclusion: The negligible improvement in the prediction performance, despite significant associations with PM and NDVI, may be due to partial mediation of these associations through the conventional cardiovascular risk factors, suggesting the importance in assessing the environmental effects on more basic physiological pathways when addressing the contribution to the cardiovascular risk. Keywords: Air pollution, Neighborhood greenness, Cardiovascular risk, Stroke, Myocardial infarction