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Coronary disease & ACSCohort study

Differential Association Between Surrounding Greenness and Mortality in Individuals With Coronary Heart Disease

JACC AdvPublished

  • 4 Israeli cohorts: 2 coronary heart disease (CHD) patient-based cohorts and 2 population-based cohorts
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Authors' conclusion

Residential greenness is associated with better survival among individuals with CHD. Variation by walkability suggests that built environment characteristics may modify greenness-related health benefits.

Study context

Population
Individuals with and without coronary heart disease (CHD) in Israel, stable and acute CHD patients and CHD-free individuals6,055 deaths during a median (IQR) follow-up of 11.8 (7.6–15.7) years · CHD-free 3,959/17,431 (22.7%) · stable CHD 4,771/17,431 (27.3%) · acute CHD 8,701/17,431 (49.9%)
Participants
17,431 individuals
Exposure
Greenness and mortality among individuals with and without CHD
  • CHD-freen = 3,959/17,431 (22.7%)
  • stable CHDn = 4,771/17,431 (27.3%)
  • acute CHDn = 8,701/17,431 (49.9%)

Main finding

As reported in the abstract

Mortality per IQR increase in normalized difference vegetation index, by CHD status · median (IQR) follow-up of 11.8 (7.6-15.7) years
per IQR increase in normalized difference vegetation indexHazard ratio (95% CI)
stable CHD
0.90(0.81–0.99)
acute CHD
0.88(0.82–0.94)
CHD-free
1.01(0.88–1.16)

Per IQR increase in normalized difference vegetation, as printed

Observational data: associations, not effects.

Further findings

OutcomeHR (95% CI)
Greenness-mortality association by walkability tertile (all participants) — per IQR increase in normalized difference vegetation index · high walkability tertile0.83 (0.75–0.91)
Greenness-mortality association by walkability tertile (all participants) — per IQR increase in normalized difference vegetation index · medium walkability tertile0.95 (0.88–1.04)
Greenness-mortality association by walkability tertile (all participants) — per IQR increase in normalized difference vegetation index · low walkability tertile0.90 (0.82–0.98)
  • Greenness-mortality association by walkability tertile (all participants): Pinteraction = 0.05

Original publication

Differential Association Between Surrounding Greenness and Mortality in Individuals With Coronary Heart Disease. JACC Adv. Published 9 April 2026. doi:10.1016/j.jacadv.2026.102729
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Summarised from the published abstract; every number is checked against it