Greenspace, Inflammation, Cardiovascular Health, and Cancer: A Review and Conceptual Framework for Greenspace in Cardio-Oncology Research

Abstract

Cardiovascular disease (CVD) is a leading cause of global morbidity and mortality. Cancer survivors have significantly elevated risk of poor cardiovascular (CV) health outcomes due to close co-morbid linkages and shared risk factors between CVD and cancer, as well as adverse effects of cancer treatment-related cardiotoxicity. CVD and cancer-related outcomes are exacerbated by increased risk of inflammation. Results from different pharmacological interventions aimed at reducing inflammation and risk of major adverse cardiovascular events (MACEs) have been largely mixed to date. Greenspaces have been shown to reduce inflammation and have been associated with CV health benefits, including reduced CVD behavioral risk factors and overall improvement in CV outcomes. Greenspace may, thus, serve to alleviate the CVD burden among cancer survivors. To understand pathways through which greenspace can prevent or reduce adverse CV outcomes among cancer survivors, we review the state of knowledge on associations among inflammation, CVD, cancer, and existing pharmacological interventions. We then discuss greenspace benefits for CV health from ecological to multilevel studies and a few existing experimental studies. Furthermore, we review the relationship between greenspace and inflammation, and we highlight forest bathing in Asian-based studies while presenting existing research gaps in the US literature. Then, we use the socioecological model of health to present an expanded conceptual framework to help fill this US literature gap. Lastly, we present a way forward, including implications for translational science and a brief discussion on necessities for virtual nature and/or exposure to nature images due to the increasing human–nature disconnect; we also offer guidance for greenspace research in cardio-oncology to improve CV health outcomes among cancer survivors.

The impact of greenspace or nature-based interventions on cardiovascular health or cancer-related outcomes: A systematic review of experimental studies

“…Existing conceptual models such as the “ Greenspace and Health Equity model ” [ 169 ] or the “ Greenspace in Cardio-Oncology model” [ 1 ] can be very useful in future research on greenspace and CardioOncology disparities. There is a need for increased research funding from relevant organizations such as the American Heart Association, the American Cancer Society, and National Health Institutes including the National Cancer Institute.…”

“…Cardiovascular disease (CVD) is the leading cause of global morbidity and mortality [ 1 , 2 ]. In 2019, CVD accounted for approximately 18.6 million deaths globally [ 3 ].…”

“…CVD and cancer have close co-morbid linkages due to multiple shared risk factors [ 7 ], which put cancer survivors at a disproportionate risk for CVD [ 1 , 8 ]. CVD and cancer are closely linked in a bidirectional causal relationship whereby having one of the diseases puts the patient at an increased risk of having the other [ 8 , 9 ].…”

“…Some of this evidence was found through experimental studies, suggesting possible causal relationships, and opportunities for specific interventions to improve CVD and cancer-related health outcomes. However these experimental studies have not yet been systematically reviewed to bring all existing evidence together [ 1 ]. In this review, we sought to systematically summarize findings from experimental studies with greenspace interventions and identify potential literature gaps for future research.…”

Cardiooncology: current status of the issue, interdisciplinary interaction

“…Современные исследования указывают на высокий риск возникновения и широкую распространенность кардиоваскулярной патологии среди пациентов, получивших противоопухолевое лечение [35]. Проблемы кардиотоксических эффектов химиотерапии, методов профилактики и лечения, коморбидности и качества жизни онкологических больных с ССО являются чрезвычайно актуальными и одновременно недостаточно изученными, что требует проведения дальнейших исследований в области кардиоонкологии.…”