Air pollution, neighbourhood walkability and cerebrovascular small vessel disease in patients with cardiovascular disorders along the heart-brain axis.
8 affiliations
- 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
- 2Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
- 3Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
- 4Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, the Netherlands.
- 5Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.
- 6Department of Internal Medicine, Section Geriatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.
- 7Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands.
- 8Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.
Abstract
Background
We investigated if ambient air pollution and neighbourhood walkability associate with presence and progression of cerebral small vessel disease (CSVD) in patients with cardiovascular disorders along the heart-brain axis.Methods
Data from patients with heart failure, carotid occlusive disease, or vascular cognitive impairment (30% women; mean age 69.0 years) of the Heart-Brain Connection study were used. Brain parenchymal fraction (BPF), white matter hyperintensity fraction (WMH), cerebral blood flow (CBF), and incident vascular lesions were assessed with 3T brain MRI at baseline (n = 300) and at two years follow-up (n = 181). Incident clinical cerebrovascular events were assessed with questionnaires and telephone interviews up to five years. Annual residential nitrogen dioxide (NO₂; µg/m³) concentration was linked to participants at baseline. Neighbourhood walkability was measured using the Dutch walkability index within a 500-m Euclidean buffer around each residential-area centroid (range 0-100). Associations were analyzed using age- and sex-adjusted logistic regression and repeated-measures linear mixed models.Results
At baseline, no association was found between NO₂ or walkability and BPF, WMH, CBF, infarcts or microbleeds. Walkability (per 10 units) was associated with lower odds for having infarcts at baseline (OR 0.82, 95%CI 0.96-0.99) and attenuated age-related WMH increases by 0.01 SD (95%CI 0.00-0.02) per year. In longitudinal analyses, no associations between NO₂ or walkability and progression of vascular brain lesions, cerebrovascular events, or mortality were found.Conclusion
Although air pollution and neighbourhood walkability were not strongly associated with CSVD progression, stroke, or mortality, higher walkability appeared to modestly attenuate age-related increases in WMH.
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BibTeX
@article{rissanen2026pollution,
title = {{Air pollution, neighbourhood walkability and cerebrovascular small vessel disease in patients with cardiovascular disorders along the heart-brain axis.}},
author = {Ina Rissanen and Erik J Timmermans and Jeroen de Bresser and Esther E Bron and Anna E Leeuwis and Majon Muller and Matthias J P van Osch and Betty M Tijms and Geert Jan Biessels and Ilonca Vaartjes and Heart-Brain Connection Consortium},
journal = {Cerebral circulation - cognition and behavior},
year = {2026},
month = oct,
doi = {10.1016/j.cccb.2026.100565},
url = {https://europepmc.org/article/MED/42898191},
note = {CC BY},
}
RIS
TY - JOUR
TI - Air pollution, neighbourhood walkability and cerebrovascular small vessel disease in patients with cardiovascular disorders along the heart-brain axis.
AU - Ina Rissanen
AU - Erik J Timmermans
AU - Jeroen de Bresser
AU - Esther E Bron
AU - Anna E Leeuwis
AU - Majon Muller
AU - Matthias J P van Osch
AU - Betty M Tijms
AU - Geert Jan Biessels
AU - Ilonca Vaartjes
AU - Heart-Brain Connection Consortium
PY - 2026
DA - 2026/10/03
JO - Cerebral circulation - cognition and behavior
DO - 10.1016/j.cccb.2026.100565
UR - https://europepmc.org/article/MED/42898191
AB - Background We investigated if ambient air pollution and neighbourhood walkability associate with presence and progression of cerebral small vessel disease (CSVD) in patients with cardiovascular disorders along the heart-brain axis.Methods Data from patients with heart failure, carotid occlusive disease, or vascular cognitive impairment (30% women; mean age 69.0 years) of the Heart-Brain Connection study were used. Brain parenchymal fraction (BPF), white matter hyperintensity fraction (WMH), cerebral blood flow (CBF), and incident vascular lesions were assessed with 3T brain MRI at baseline (n = 300) and at two years follow-up (n = 181). Incident clinical cerebrovascular events were assessed with questionnaires and telephone interviews up to five years. Annual residential nitrogen dioxide (NO₂; µg/m³) concentration was linked to participants at baseline. Neighbourhood walkability was measured using the Dutch walkability index within a 500-m Euclidean buffer around each residential-area centroid (range 0-100). Associations were analyzed using age- and sex-adjusted logistic regression and repeated-measures linear mixed models.Results At baseline, no association was found between NO₂ or walkability and BPF, WMH, CBF, infarcts or microbleeds. Walkability (per 10 units) was associated with lower odds for having infarcts at baseline (OR 0.82, 95%CI 0.96-0.99) and attenuated age-related WMH increases by 0.01 SD (95%CI 0.00-0.02) per year. In longitudinal analyses, no associations between NO₂ or walkability and progression of vascular brain lesions, cerebrovascular events, or mortality were found.Conclusion Although air pollution and neighbourhood walkability were not strongly associated with CSVD progression, stroke, or mortality, higher walkability appeared to modestly attenuate age-related increases in WMH.
SN - 2666-2450
ER -