Impact of environmental factors on cardiovascular health in Castilla-La Mancha: the CarVasCLiMa cohort study protocol

Introduction The CarVasCLiMa project aims to investigate the associations between environmental factors and cardiovascular health outcomes in the population of Castilla-La Mancha. Methods and analysis The study will include a representative cohort of residents from urban, semiurban and rural areas, followed over a 2-year period. Environmental exposure variables, including air pollution and climate conditions, will be assessed using high-resolution satellite data complemented by data from local monitoring stations. Proximity to green spaces will be estimated using the Normalised Difference Vegetation Index and geospatial data. Cardiovascular outcomes will include measurements of blood pressure, arterial stiffness and circulating biomarkers such as C-reactive protein. In addition, validated questionnaires will be administered to assess quality of life, emotional well-being and lifestyle factors. Data analysis will involve advanced statistical modelling to examine longitudinal associations between environmental and lifestyle factors and cardiovascular outcomes, including sex-stratified analyses and specific evaluations of vulnerable population subgroups. Ethics and dissemination This protocol was previously approved by the Clinical Research Ethics Committee of the Health Area in the city of Cuenca (REG: 2025/PI1625). This approach will enable the identification of differential susceptibility to environmental and lifestyle factors and support the development of targeted prevention strategies. Finally, the findings of this study are expected to inform the development of public health policies tailored to the regional context, contributing to the mitigation of environmental risks and the improvement of cardiovascular health and overall quality of life in Castilla-La Mancha.