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Lifestyle choices like diet and exercise affect the risk of cardiovascular disease (CVD), but these choices are also influenced by the places we live. These places, called the built environment, are man-made areas where people spend most of their time. This PhD thesis looks at how features of neighbourhoods affect heart health, CVD, and death in adults.

Chapter 2 reviews 51 earlier literature studies. It finds strong evidence that air pollution, noise from traffic, and hot temperatures increase the risk of CVD. Green areas, like parks, may help protect heart health. There was less strong evidence for other neighbourhood features.

Chapter 3 looks at food environments. A review showed that areas with more fast-food restaurants often have higher levels of CVD and deaths, although results are not always the same. A study with 4.2 million people found that unhealthy food areas were linked to more deaths from diseases related to obesity, especially heart-related conditions.

Chapter 4 includes a national study from the Netherlands with 3 million people. It showed that people living in neighbourhoods with low or changing levels of walkability had a higher risk of getting CVD than those in persistently walkable areas.

Chapter 5 focused on whether obesogenic neighbourhood environments, which includes various aspects from the food and physical activity environment, affect clinical CVD risk factors and long-term CVD incidence. We used a previously developed Obesogenic Built-environmental CharacterisTics (OBCT) index, to quantify the obesogenicity of neighbourhoods. We found that these neighbourhoods are linked to higher BMI, obesity, high blood pressure, and waist circumference. In a study of 4.4 million adults, more obesogenic areas were linked to a higher risk of CVD over 14 years.

This thesis highlights that the built environment in which people live plays a role in their heart health. Research like this helps us make better choices for healthier neighbourhoods and preventing cardiovascular diseases.