Review Article

Influence of urban and transport planning and the city environment on cardiovascular disease



This Review describes the relationship between urban and transport planning and the city environment, the main cardiovascular risk factors (including physical activity, hypertension, and obesity), and cardiovascular disease and mortality. Good evidence exists for a relationship between built environment measures (such as mixed land use, connectivity and walkability, and physical activity), environmental exposures (such as green space, air pollution, and noise), and cardiovascular disease and mortality. Some good evidence exists for a link between transport mode and cardiovascular disease, but evidence is inconsistent for an association between built environment measures and weight status, and between green space and either weight status or physical activity. Further research is needed into the influence of built environment measures on cardiovascular disease and mortality. Urban and transport planning has an important effect on cardiovascular health and its risk factors. Cardiovascular disease and mortality could be reduced by better urban and transport planning that promotes physical activity; reduces levels of air pollution, noise, and heat island effects; and increases green space.

Key points

  • Urban and transport planning affects cardiovascular health and its risk factors, including hypertension, physical activity, and obesity.

  • Good evidence exists for a relationship between built environment measures (mixed land use, connectivity and walkability, and physical activity), environmental exposures (green space, air pollution, and noise), and cardiovascular disease and mortality.

  • Cardiovascular disease and mortality could be reduced by improved urban and transport planning that promotes physical activity; reduces levels of air pollution, noise, and heat island effects; and increases green space.

  • A move away from car-centric sprawling cities towards more compact, less car-dependent cities, and greener cities with mixed land use, more public and active transport, and greener infrastructure is needed.

  • Health impact assessment tools have become available to estimate the health effects of healthy urban and transport planning and should be used to promote further healthy development.

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Review criteria

PubMed, Web of Science, Science Direct, and reference lists from relevant articles were searched for English language articles published between 1 January 1980 and 1 December 2017, using the search terms “city” and “urban” in combination with “air pollution”, “noise”, “temperature”, “green space”, “heat island”, “built environment”, “mixed land use”, “walkability”, “density”, “connectivity”, “physical activity”, “obesity”, “overweight”, “cardiovascular mortality”, “cardiovascular disease”, “hypertension”, and “blood pressure”. I focused on systematic reviews, meta-analyses, and articles published in the past 5 years; however, I used older articles if they represented seminal research or were necessary to understand more recent findings. I gave priority to systematic reviews and meta-analyses in the reporting because they provide overall summaries of the current state of work.

Author information


  1. ISGlobal, Barcelona Institute for Global Health - Campus MAR, Barcelona Biomedical Research Park (PRBB), Barcelona, Spain

    • Mark J. Nieuwenhuijsen


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Competing interests

The author declares no competing interests.

Corresponding author

Correspondence to Mark J. Nieuwenhuijsen.