The associations of residential greenness with cortisol in patients with heart failure

ABSTRACT

Heart failure (HF) is the leading cause of hospitalizations in cardiovascular disease patients, in many countries, including the United States, Europe, and Lithuania. HF patients often have elevated cortisol levels, associated with higher mortality. Urban greenery can improve physical and mental health. We hypothesize that greater residential environment greenness exposure is linked to reduced cortisol levels in symptomatic HF patients. During 2006-2009, in Kaunas, Lithuania, health data was collected from 85 urban patients (a population of ≥ 10,000 inhabitants) who underwent rehabilitation for symptomatic HF. Patients were assessed for general, cardiorespiratory systems parameters, also for blood cortisol levels at baseline and after 6 months. Greenness was assessed using the Normalized Difference Vegetation Index (NDVI) in buffer zones. A multivariate linear regression model was used to evaluate the effect of NDVI on cortisol change after 6 months. A decrease in cortisol by −30.8 mmol/l (SE = 14.7, p = 0.036) was associated with a 0.1 higher level of NDVI at 300 m. NDVI effect was stronger when cortisol test was done after 10 AM and in patients with ejection fraction < 30%. Our results confirm that greenness was related to a decrease in cortisol levels after 6 months in patients with symptomatic HF.

KEYWORDS:

• Greenness
• stress
• cortisol
• urban patients
• heart failure

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No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Sonata Cerkauskaite

Sonata Cerkauskaite is a PhD student in ecological and environmental studies at the Vytautas Magnus University. The topic of the dissertation work and research is the effect of meteorological, heliophysical factors and greenness on the psychological state and physiological indicators.

Raimondas Kubilius

Raimondas Kubilius is a Professor, as well as the Head and a cardiologist of the Department of Rehabilitation, Lithuanian University of Health Sciences. Field of interest: peculiarities of rehabilitation of patients with heart and blood vessel diseases, long-term physical training effect on the cardiovascular system.

Sandra Andrusaityte

Sandra Andrusaityte is an Associate Professor at the Department of Environmental Sciences, Vytautas Magnus University. Areas of scientific interest: environmental epidemiology, impact of environmental factors on children’s health, assessment of the risks posed by the urban environment to the health of adults, risk assessment in environmental epidemiological studies using statistical analysis packages.

Jone Vencloviene

Jone Vencloviene is a Professor at Department of Environmental Sciences, Vytautas Magnus University and Senior Researcher at the Institute of Cardiology, Lithuanian University of Health Sciences. Areas of scientific interest: biostatistics, impact of meteorological and heliogeophysical conditions on the environment and human health, as well as short-term impact of air pollution on human health. Vencloviene has many years of scientific experience and is a co-author of many scientific studies.