Association Between Perceived Neighborhood Characteristics and Carotid Artery Intima-Media Thickness: Cross-Sectional Results From the ELSA-Brasil Study

Glob Heart. 2019 Dec;14(4):379-385. doi: 10.1016/j.gheart.2019.09.002.


Background: Living in a neighborhood with a low socioeconomic context may increase the risk of coronary heart disease. However, few studies have explored the impact of neighborhood characteristics on subclinical atherosclerosis, and their role as a risk factor for cardiovascular disease has not yet been studied in poor countries.

Objectives: This study aimed to investigate the association between perceived neighborhood characteristics and subclinical atherosclerosis in a large sample of adults, using cross-sectional data from the ELSA-Brasil (Brazilian Longitudinal Study of Adult Health).

Methods: Participants free of clinical coronary artery disease answered a questionnaire designed to assess their perceptions regarding 6 neighborhood dimensions: social cohesion, walkability, availability of healthy food, safety, witnessed violence, and personal victimization. The scores of each domain were used as independent variables. Common carotid intima-media thickness (CCIMT) was used as a dependent variable. Then linear regression models, adjusted by demographic, socioeconomic, and cardiovascular factors, were used.

Results: A total of 9,923 adults (mean age = 51.5 ± 8.9 years, 44% male, 55% white) were examined. In the univariate analysis, better walkability (β = -0.62, 95% confidence interval [CI]: -1.01 to -0.23; p = 0.002) and low witnessed violence (β = -1.95; 95% CI: -2.96 to -0.94; p < 0.0001) were associated with lower CCIMT, whereas low personal victimization was associated with higher CCIMT (β = 10.70; 95% CI: 4.55 to 16.85; p = 0.001). A borderline interaction between neighborhood domain and sex was found. Better social cohesion may be associated with larger CCIMT among women, whereas better safety was associated with lower CCIMT among men. Multiple imputation for missing CCIMT data showed similar results.

Conclusions: The perception of living in a more walkable environment and in a neighborhood where people witness fewer violent episodes can provide protection on the early phases of the atherosclerosis process. Less stress and the practice of physical activity may explain the protection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude to Health*
  • Brazil / epidemiology
  • Carotid Intima-Media Thickness
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / psychology
  • Coronary Disease / diagnostic imaging
  • Coronary Disease / epidemiology
  • Coronary Disease / psychology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Perception
  • Residence Characteristics*
  • Socioeconomic Factors
  • Surveys and Questionnaires