Association Between Visual Acuity and Incident Atherosclerotic Cardiovascular Disease: A Longitudinal Test of Mediators

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. This study aims to investigate the relationship between VA and ASCVD event...

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Main Authors: Zijing Du, Xiayin Zhang, Gabriella Bulloch, Feng Zhang, Yu Huang, Yaxin Wang, Yingying Liang, Guanrong Wu, Zhuoting Zhu, Xianwen Shang, Yijun Hu, Xiaohong Yang, Honghua Yu
Format: Article
Language:English
Published: Ubiquity Press 2025-02-01
Series:Global Heart
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Online Access:https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1406
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author Zijing Du
Xiayin Zhang
Gabriella Bulloch
Feng Zhang
Yu Huang
Yaxin Wang
Yingying Liang
Guanrong Wu
Zhuoting Zhu
Xianwen Shang
Yijun Hu
Xiaohong Yang
Honghua Yu
author_facet Zijing Du
Xiayin Zhang
Gabriella Bulloch
Feng Zhang
Yu Huang
Yaxin Wang
Yingying Liang
Guanrong Wu
Zhuoting Zhu
Xianwen Shang
Yijun Hu
Xiaohong Yang
Honghua Yu
author_sort Zijing Du
collection DOAJ
description 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. This study aims to investigate the relationship between VA and ASCVD events, including the mediation effects of potential factors. Methods: A prospective study was conducted using data from 110,522 participants in the UK Biobank, all of whom had baseline visual acuity (VA) measurements collected between 2006 and 2010. VA was assessed using the logarithm of the minimum angle of resolution (logMAR) chart, with the better-seeing eye selected for analysis. Incident ASCVD events were obtained from hospital admissions and death records up to April 2021. The longitudinal association between VA and ASCVD was examined using Cox proportional hazards models. A four-way decomposition mediation analysis was performed to quantify the indirect effects of hypertension, diabetes, depression, and socioeconomic status in mediating the relationship between VA and ASCVD. Results: Over an 11.13-year median follow-up, 5,496 ASCVD cases were recorded. A one-line worsening in VA (0.1 logMAR increase) was associated with an increased risk of ASCVD (HR = 1.63; 95%CI = 1.35–1.96, P < 0.001). Mediation analysis showed that hypertension, diabetes, depression, and Townsend deprivation index contributed 3.8%, 3.3%, 5.7%, and 5.9% to this association, respectively (all P < 0.05). Notably, depression was the strongest mediator, accounting for 10.0% of the association in women (P < 0.05). Conclusions: Our study demonstrates that visual decline is associated with an increased risk of ASCVD. Early intervention through regular eye exams can help mitigate the risk of ASCVD in middle-aged and older adults. Additionally, mental health is a key mediator in the VA-ASCVD relationship, particularly among women.
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spelling doaj-art-6467faf10f684739b65e9b0f3d2ca44e2025-08-20T03:01:46ZengUbiquity PressGlobal Heart2211-81792025-02-01201191910.5334/gh.14061387Association Between Visual Acuity and Incident Atherosclerotic Cardiovascular Disease: A Longitudinal Test of MediatorsZijing Du0https://orcid.org/0000-0002-8676-8293Xiayin Zhang1Gabriella Bulloch2Feng Zhang3Yu Huang4Yaxin Wang5Yingying Liang6Guanrong Wu7Zhuoting Zhu8Xianwen Shang9Yijun Hu10Xiaohong Yang11Honghua Yu12https://orcid.org/0000-0002-0782-346XGuangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, GuangzhouGuangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, GuangzhouCentre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VICGuangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou; Department of Ophthalmology, Linyi People’s Hospital, Linyi 276003, ShandongGuangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, GuangzhouGuangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, GuangzhouGuangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, GuangzhouGuangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, GuangzhouCentre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VICExperimental Ophthalmology, The Hong Kong Polytechnic University, Hong KongGuangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, GuangzhouGuangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, GuangzhouGuangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou; Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080Background: 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. This study aims to investigate the relationship between VA and ASCVD events, including the mediation effects of potential factors. Methods: A prospective study was conducted using data from 110,522 participants in the UK Biobank, all of whom had baseline visual acuity (VA) measurements collected between 2006 and 2010. VA was assessed using the logarithm of the minimum angle of resolution (logMAR) chart, with the better-seeing eye selected for analysis. Incident ASCVD events were obtained from hospital admissions and death records up to April 2021. The longitudinal association between VA and ASCVD was examined using Cox proportional hazards models. A four-way decomposition mediation analysis was performed to quantify the indirect effects of hypertension, diabetes, depression, and socioeconomic status in mediating the relationship between VA and ASCVD. Results: Over an 11.13-year median follow-up, 5,496 ASCVD cases were recorded. A one-line worsening in VA (0.1 logMAR increase) was associated with an increased risk of ASCVD (HR = 1.63; 95%CI = 1.35–1.96, P < 0.001). Mediation analysis showed that hypertension, diabetes, depression, and Townsend deprivation index contributed 3.8%, 3.3%, 5.7%, and 5.9% to this association, respectively (all P < 0.05). Notably, depression was the strongest mediator, accounting for 10.0% of the association in women (P < 0.05). Conclusions: Our study demonstrates that visual decline is associated with an increased risk of ASCVD. Early intervention through regular eye exams can help mitigate the risk of ASCVD in middle-aged and older adults. Additionally, mental health is a key mediator in the VA-ASCVD relationship, particularly among women.https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1406visual acuityatherosclerotic cardiovascular diseasemediatorsolder adultslongitudinal
spellingShingle Zijing Du
Xiayin Zhang
Gabriella Bulloch
Feng Zhang
Yu Huang
Yaxin Wang
Yingying Liang
Guanrong Wu
Zhuoting Zhu
Xianwen Shang
Yijun Hu
Xiaohong Yang
Honghua Yu
Association Between Visual Acuity and Incident Atherosclerotic Cardiovascular Disease: A Longitudinal Test of Mediators
Global Heart
visual acuity
atherosclerotic cardiovascular disease
mediators
older adults
longitudinal
title Association Between Visual Acuity and Incident Atherosclerotic Cardiovascular Disease: A Longitudinal Test of Mediators
title_full Association Between Visual Acuity and Incident Atherosclerotic Cardiovascular Disease: A Longitudinal Test of Mediators
title_fullStr Association Between Visual Acuity and Incident Atherosclerotic Cardiovascular Disease: A Longitudinal Test of Mediators
title_full_unstemmed Association Between Visual Acuity and Incident Atherosclerotic Cardiovascular Disease: A Longitudinal Test of Mediators
title_short Association Between Visual Acuity and Incident Atherosclerotic Cardiovascular Disease: A Longitudinal Test of Mediators
title_sort association between visual acuity and incident atherosclerotic cardiovascular disease a longitudinal test of mediators
topic visual acuity
atherosclerotic cardiovascular disease
mediators
older adults
longitudinal
url https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1406
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