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

BACKGROUND: Residential greenness has been linked to lower mortality; however, whether this association varies by cardiovascular disease status remains unclear. OBJECTIVES: The objectives of the study were to examine the association between greenness and mortality among individuals with and without coronary heart disease (CHD), distinguishing between stable and acute patients, and to assess modification by individual- and neighborhood-level factors, including walkability. METHODS: We analyzed data from 4 Israeli cohorts: 2 CHD patient-based cohorts and 2 population-based cohorts (inception years 1992-2004; mortality follow-up through 2020). Long-term greenness exposure was estimated using satellite-based Normalized Difference Vegetation Index within an 800m buffer around participants' homes. RESULTS: = 0.05). CONCLUSIONS: 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.