Urban environments contribute substantially to the rising burden of cardiometabolic diseases worldwide. Cities are complex adaptive systems that continually exchange resources, shaping exposures relevant to human health such as air pollution, noise, and chemical exposures. 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.

中文翻译：

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城市环境与心脏代谢健康

城市环境在很大程度上加剧了全球心脏代谢疾病负担的增加。城市是复杂的适应性系统，不断交换资源，塑造与人类健康相关的暴露，例如空气污染、噪音和化学暴露。此外，城市基础设施和供应系统通过各种途径影响健康风险的多个领域，包括行为、心理压力、污染和营养（例如，缺乏身体活动、空气污染、噪音、热应激、粮食系统、绿地的可用性）和污染物暴露）。除了心脏代谢健康之外，城市设计还可能通过能源和材料消耗影响气候变化，这些消耗与心脏代谢疾病有许多相同的驱动因素。专注于发展可持续紧凑城市的综合空间规划可以同时创建有益于心脏健康和环境健康的城市设计。本文回顾了系统科学框架内城市暴露组（一个人经历的暴露的总体，包括环境、职业、生活方式、社会和心理因素）与心脏代谢疾病之间关联的现有证据，并探讨了城市规划原则（例如，连通性、密度、土地利用的多样性、目的地可达性和交通距离）。我们强调了关于优化心脏代谢健康结果的建筑环境特征阈值的关键知识差距。最后，我们讨论新兴模型和指标，使城市发展与减轻心脏代谢疾病和通过跨部门合作、治理和社区参与减少气候变化的双重目标保持一致。本次审查表明，城市是实施政策和干预措施以同时应对心血管疾病和气候变化全球流行病的关键环境。