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. 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 longitudinalassociation 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.