Preventing cardiovascular disease within the built and living environment: An Expert Opinion

Abstract Cardiovascular (CV) health is influenced not only by biological factors but also by the environments in which people live. The environment comprises interconnected built, living, and social domains that shape health behaviours, psychosocial well-being, environmental exposures, and access to resources. Within this framework, the built environment, the human-made settings that structure daily life, plays a key role in influencing physical activity, dietary behaviours, social interactions, safety, and overall well-being. Neighbourhoods are embedded within historical, legal, political, cultural, and economic contexts that shape the social determinants of health and contribute to CV health. Growing evidence indicates that characteristics of the living environment substantially influence cardiovascular disease (CVD) and related disorders, through multiple pathways. These include access to healthcare, air and noise pollution, availability of healthy foods and green spaces, physical activity, social cohesion, and chronic psychosocial stress. Potential mechanisms include inflammation, oxidative stress, neuroendocrine dysregulation, unhealthy lifestyle behaviours, and persistent stress responses that promote cardiometabolic dysfunction and vascular disease. This expert opinion examines challenges and opportunities related to nutrition, physical activity, environmental quality, community engagement, and occupational as well as social dimensions of the living environment from a public health perspective. This document highlights the importance of designing healthier communities that support CV health and reduce disease burden. Furthermore, neighbourhoods may serve as measurable units for monitoring CVD and broader health outcomes by integrating environmental characteristics with CV metrics, electronic health records, geospatial data, and neighbourhood-level social risk indicators. Addressing environmental determinants across multiple scales supports targeted public health strategies in Europe and globally.