Previously submitted to: JMIR Public Health and Surveillance (no longer under consideration since Mar 16, 2024)
Date Submitted: May 16, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Association between Visual Acuity and Incident Atherosclerotic Cardiovascular Disease: A Longitudinal Test of Mediators
ABSTRACT
Background:
Little is known about the prospective relationship between visual acuity (VA) and atherosclerotic cardiovascular disease (ASCVD) events, and the extent to which this association is mediated via potential mediators.
Objective:
To investigate the relationship between VA and ASCVD events, and to investigate the extent to which this association is mediated via potential mediators.
Methods:
A prospective population-based study analyzed data of participants aged 38-73 years from the UK Biobank cohort with baseline VA were included between 2006 and 2010. Habitual distance VA in the better-seeing eye was used for analysis. Data on ASCVD incidents was ascertained using hospital inpatient and death records until April 2021. Potential mediators used in the mediation analysis included hypertension, diabetes, depression and socioeconomic status.
Results:
Of 110,554 participants with available VA assessments and without ASCVD history at baseline, 61,518 (55.64%) were women and mean (SD) age was 56.43 (8.02) years. Over a median follow-up of 11.13 years, 5,496 cases of incident ASCVD were documented. After adjusting for all confounders, a one-line worse VA (0.1 LogMAR increase) was associated with an increased risk of incident ASCVD (HR= 1.62; 95%CI: 1.34-1.96, P < 0.001). In the mediation analysis, hypertension, diabetes, depression, and Townsend deprivation index attributed 3.8%, 3.3%, 5.7% and 5.9% to this association, respectively (all p-value for indirect effect < 0.05). Notably, the strongest indirect association was with depression and accounted for 10.0% (P for indirect effect < 0.05) of the association to ASVCD among women.
Conclusions:
Our study demonstrates that visual decline is associated with an increased risk of ASCVD. We should intervene mediation factors in the early stage of vision decline through regular ophthalmic examination to reduce the ASCVD burden of the elderly, and attention should be paid to the impact of mental health on ASCVD, especially in older women. Clinical Trial: N/A
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