Whether residential greenness is associated with mortality across coronary heart disease (CHD) subgroups remains unclear. An analysis of four cohorts published in JACC: Advances evaluated long-term greenness exposure and mortality among individuals with and without CHD, including stable and acute presentations.

Data were drawn from two CHD cohorts and two population-based cohorts in Israel, initiated between 1992 and 2004, with mortality follow-up through 2020. Greenness exposure was estimated using satellite-derived Normalized Difference Vegetation Index (NDVI) within an 800 m residential buffer. A total of 17,431 participants (mean age 63.6 ± 15.3 years; 30.3% women) were included. At baseline, 22.7% were CHD-free, 27.3% had stable CHD, and 49.9% had acute CHD. Over a median follow-up of 11.8 years, 6,055 deaths occurred.

Higher greenness exposure was associated with lower mortality among individuals with stable CHD (HR 0.90; 95% CI 0.81-0.99) and acute CHD (HR 0.88; 95% CI 0.82-0.94), per IQR increase in NDVI. No significant association was observed in CHD-free individuals (HR 1.01; 95% CI 0.88-1.16; Pinteraction=0.004). Stratified analyses showed the strongest association in areas with high walkability (HR 0.83; 95% CI 0.75-0.91), compared with medium (HR 0.95; 95% CI 0.88-1.04) and low walkability settings (HR 0.90; 95% CI 0.82-0.98; Pinteraction=0.05). 

These findings indicate that residential greenness was associated with lower mortality among individuals with CHD, with variation by walkability.