Health care providers have long advised their patients to adopt healthy diets, regular exercise and good sleep habits to reduce cardiometabolic risks. However, an equally important factor is the environment in which patients live. The level of air pollution in their community and the availability of safe, accessible places for physical activity can significantly impact health outcomes.

With 99% of the global population, including some residents in the Greater Houston area, living in environments with unsafe air pollution levels; Al-Kindi is working to understand the connection between air pollution and other environmental factors with cardiovascular disease, aiming to develop mitigation strategies. Even in areas without excessive air pollution, the human-made structures and spaces where we live, work and play are closely linked with cardiovascular health. Previous studies often relied on broad population data or single metrics, neglecting the complex interplay of neighborhood characteristics.

Al-Kindi's team analyzed data from 1.07 million patients in the Houston Methodist Learning Health System Outpatient Registry. Each patient was assigned a NatureScore™, which measures the quality and quantity of nature in their area, and a WalkScore, assessing neighborhood walkability. The study, published in JACC: Advances, revealed that living in highly walkable neighborhoods with ample nature exposure significantly reduced the odds of cardiovascular risk factors. Further, Al-Kindi employed deep learning to analyze Google satellite imagery across seven U.S. cities, linking built environment features to neighborhood-level heart disease rates, as published in the European Heart Journal and JAMA Cardiology. These machine vision-derived features better predict heart disease prevalence than traditional demographic and socioeconomic data alone. “The implications of this work are profound, offering scalable tools to assess environmental impacts on heart health, potentially guiding interventions to tackle health disparities and improve cardiovascular outcomes across U.S. communities,” said Al-Kindi.

Houston Methodist researchers have discovered that certain components of so-called "good" cholesterol–HDL–may be associated with an increased risk of cardiovascular disease. Led by Henry J. Pownall, PhD, Professor of Biochemistry in Medicine and Khurram Nasir, MD, the research team is investigating the role of certain properties of HDL-C in heart health.

“During routine checkups, adults have their cholesterol levels tested, which includes both "bad" LDL cholesterol and "good" HDL cholesterol,” said Pownall, who is the lead author on a paper recently published in Journal of Lipid Research. “Not all cholesterol, however, is born the same. What is not commonly recognized is that each type of cholesterol has two forms—free cholesterol, which is active and involved in cellular functions, and esterified or bound cholesterol, which is more stable and ready to be stored in the body. Too much free cholesterol, even if it is in HDL, could contribute to heart disease.” In pre-clinical studies, the team discovered that HDL with a high content of free cholesterol is likely dysfunctional. To validate their findings, they are currently at the halfway point of the NIH-funded Houston Heart Study with 400 patients with a range of plasma HDL concentrations.

While it was previously thought that the transfer of free cholesterol to HDL was beneficial for heart health by removing excess cholesterol from tissues, the data shows that in the context of high plasma HDL concentrations, the reverse is true—free cholesterol transfer from HDL to the white blood cells in blood and tissues could actually raise one’s risk for cardiovascular disease. Once they reach their immediate goal of showing that excess free cholesterol in HDL is associated with excess cardiovascular disease, the research team plans to develop new diagnostics and treatments for managing heart disease, as well as use HDL-free cholesterol as a biomarker to identify patients requiring HDL-lowering therapies.