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In addition, urban infrastructure and provisioning systems influence multiple domains of health risk, including behaviors, psychological stress, pollution, and nutrition through various pathways (eg, physical inactivity, air pollution, noise, heat stress, food systems, the availability of green space, and contaminant exposures). Beyond cardiometabolic health, city design may also affect climate change through energy and material consumption that share many of the same drivers with cardiometabolic diseases. Integrated spatial planning focusing on developing sustainable compact cities could simultaneously create heart-healthy and environmentally healthy city designs. This article reviews current evidence on the associations between the urban exposome (totality of exposures a person experiences, including environmental, occupational, lifestyle, social, and psychological factors) and cardiometabolic diseases within a systems science framework, and examines urban planning principles (eg, connectivity, density, diversity of land use, destination accessibility, and distance to transit). We highlight critical knowledge gaps regarding built-environment feature thresholds for optimizing cardiometabolic health outcomes. Last, we discuss emerging models and metrics to align urban development with the dual goals of mitigating cardiometabolic diseases while reducing climate change through cross-sector collaboration, governance, and community engagement. This review demonstrates that cities represent crucial settings for implementing policies and interventions to simultaneously tackle the global epidemics of cardiovascular disease and climate change.<\/jats:p>","DOI":"10.1161\/circulationaha.123.067461","type":"journal-article","created":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T14:00:47Z","timestamp":1713189647000},"page":"1298-1314","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":90,"title":["The Urban Environment and Cardiometabolic Health"],"prefix":"10.1161","volume":"149","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6669-8163","authenticated-orcid":true,"given":"Sanjay","family":"Rajagopalan","sequence":"first","affiliation":[{"name":"Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH (S.R., A.V.-M., J.Z., I.J.N., J.-E.D., Z.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"Vergara-Martel","sequence":"additional","affiliation":[{"name":"Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH (S.R., A.V.-M., J.Z., I.J.N., J.-E.D., Z.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1711-3155","authenticated-orcid":true,"given":"Jeffrey","family":"Zhong","sequence":"additional","affiliation":[{"name":"Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH (S.R., A.V.-M., J.Z., I.J.N., J.-E.D., Z.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0003-5089","authenticated-orcid":true,"given":"Haitham","family":"Khraishah","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD (H.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3750-9789","authenticated-orcid":true,"given":"Mikhail","family":"Kosiborod","sequence":"additional","affiliation":[{"name":"Mid America Heart Institute, Kansas City, KS (M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2831-3618","authenticated-orcid":true,"given":"Ian J.","family":"Neeland","sequence":"additional","affiliation":[{"name":"Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH (S.R., A.V.-M., J.Z., I.J.N., J.-E.D., Z.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Eudes","family":"Dazard","sequence":"additional","affiliation":[{"name":"Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH (S.R., A.V.-M., J.Z., I.J.N., J.-E.D., Z.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuo","family":"Chen","sequence":"additional","affiliation":[{"name":"Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH (S.R., A.V.-M., J.Z., I.J.N., J.-E.D., Z.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5503-4150","authenticated-orcid":true,"given":"Thomas","family":"Munzel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (T.M.)."},{"name":"German Centre for Cardiovascular Research, Partner Site Rhine Main (T.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8521-7262","authenticated-orcid":true,"given":"Robert D.","family":"Brook","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Department of Internal Medicine, Wayne State University, Detroit, MI (R.D.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Nieuwenhuijsen","sequence":"additional","affiliation":[{"name":"ISGlobal, Barcelona Institute for Global health, Spain (M.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hovmand","sequence":"additional","affiliation":[{"name":"Center for Community Health Integration, Case Western Reserve University, Cleveland, OH (P.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1122-7695","authenticated-orcid":true,"given":"Sadeer","family":"Al-Kindi","sequence":"additional","affiliation":[{"name":"DeBakey Heart and Vascular Center, Houston Methodist, TX (S.A.-K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","unstructured":"Aubrey D. 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