Graphical Abstract
Visual acuity and ASCVD in middle-aged and older adults.
Table 1
Cohort characteristics by VA tertile.
| CHARACTERISTIC | HIGHEST VA LEVEL (N = 39,168) | MIDDLE VA LEVEL (N = 36,130) | LOWEST VA LEVEL (N = 35,224) | P VALUE |
|---|---|---|---|---|
| Age, mean (SD), yrs | 54.17 (8.23) | 56.94 (7.92) | 58.81 (7.45) | <0.001 |
| Gender, No. (%) | <0.001 | |||
| Women | 19,840 (50.65) | 20,888 (57.81) | 20,772 (58.97) | |
| Men | 19,328 (49.35) | 15,242 (42.19) | 14,452 (41.03) | |
| Ethnicity, No. (%) | <0.001 | |||
| White | 35,442 (90.49) | 32,246 (89.25) | 30,653 (87.02) | |
| Non-white | 3,726 (9.51) | 3,884 (10.75) | 4,571 (12.98) | |
| Townsend index, mean (SD) | –1.18 (2.89) | –0.99 (2.98) | –0.69 (3.11) | 0.004 |
| Education level, No. (%) | <0.001 | |||
| College or university degree | 15,730 (40.16) | 12,665 (35.05) | 10,626 (30.18) | |
| Others | 23,438 (59.84) | 23,465 (64.95) | 24,598 (69.82) | |
| Smoking status, No. (%) | <0.001 | |||
| Never | 22,315 (57.24) | 20,197 (56.21) | 19,378 (55.52) | |
| Former/current | 16,667 (42.76) | 15,732 (43.79) | 15,527 (44.48) | |
| Family history of ASCVD, No. (%) | <0.001 | |||
| No | 18,880 (48.20) | 16,242 (44.95) | 15,477 (43.94) | |
| Yes | 20,288 (51.80) | 19,888 (55.05) | 19,747 (56.06) | |
| Physical activity, No. (%) | 0.062 | |||
| Not meeting recommendation | 5,576 (17.06) | 5,210 (17.75) | 4,902 (17.58) | |
| Meeting recommendation | 27,105 (82.94) | 24,147 (82.25) | 22,980 (82.42) | |
| History of diabetes, No. (%) | <0.001 | |||
| No | 37,449 (95.61) | 34,054 (94.25) | 32,517 (92.31) | |
| Yes | 1,719 (4.39) | 2,076 (5.75) | 2,707 (7.69) | |
| History of hypertension, No. (%) | <0.001 | |||
| No | 11,494 (29.35) | 9,430 (26.10) | 7,982 (22.66) | |
| Yes | 27,674 (70.65) | 26,700 (73.90) | 27,242 (77.34) | |
| History of hyperlipidemia, No. (%) | <0.001 | |||
| No | 23,500 (60.00) | 20,034 (55.45) | 18,294 (51.94) | |
| Yes | 15,668 (40.00) | 16,096 (44.55) | 16,930 (48.06) | |
| History of depression, No. (%) | <0.001 | |||
| No | 37,196 (94.97) | 34,105 (94.40) | 33,184 (94.21) | |
| Yes | 1,972 (5.03) | 2,025 (5.60) | 2,040 (5.79) | |
| Systolic blood pressure | 135.33 (17.72) | 137.49 (18.49) | 139.18 (18.75) | <0.001 |
| Diastolic blood pressure | 81.81 (9.92) | 82.00 (10.02) | 82.22 (9.99) | <0.001 |
| HbA1c, mean (SD) | 35.33 (5.71) | 36.09 (6.36) | 36.89 (7.59) | <0.001 |
| LDL, mean (SD) | 3.57 (0.83) | 3.57 (0.85) | 3.57 (0.87) | 0.91 |
| HDL, mean (SD) | 1.46 (0.38) | 1.49 (0.39) | 1.49 (0.40) | <0.001 |
| Triglycerides, mean (SD) | 1.68 (0.99) | 1.68 (0.96) | 1.70 (0.98) | 0.001 |
| Cholesterol, mean (SD) | 5.71 (1.09) | 5.74 (1.12) | 5.74 (1.15) | <0.001 |
| LogMAR of visual acuity (better eye) | –0.18 (0.05) | –0.07 (0.26) | 0.13 (0.14) | <0.001 |
[i] Abbreviation: ASCVD, atherosclerotic cardiovascular disease; LogMAR, logarithm of the minimum angle of resolution; HbA1c, Glycated Hemoglobin; LDL, Low-Density Lipoprotein; HDL, High-Density Lipoprotein.
Table 2
Cox Proportional Hazards Models for Incident ASCVD by VA.
| MODEL 1 | MODEL 2 | |||
|---|---|---|---|---|
| HR (95% CI) | P VALUE | HR (95% CI) | P VALUE | |
| Total analysis | ||||
| Visual acuity (Continuous variable, per 0.1 LogMAR) | 1.97 (1.68, 2.31) | <0.001 | 1.63 (1.35, 1.96) | <0.001 |
| Visual acuity (Categorical variable) | ||||
| T1 (highest visual acuity level) | 1 [Reference] | 1 [Reference] | ||
| T2 (moderate visual acuity level) | 1.10 (1.03, 1.18) | 0.005 | 1.02 (0.94, 1.10) | 0.627 |
| T3 (lowest visual acuity level) | 1.30 (1.20, 1.37) | <0.001 | 1.17 (1.08, 1.26) | <0.001 |
| P for trend | <0.001 | <0.001 | ||
| Stratification analysis | ||||
| Stratified by gender | ||||
| Female | 1.93 (1.49, 2.51) | <0.001 | 1.46 (1.06, 2.02) | 0.020 |
| Male | 1.99 (1.62, 2.43) | <0.001 | 1.73 (1.37, 2.18) | <0.001 |
| Test for interaction | 0.725 | 0.771 | ||
[i] We used Cox proportional hazards regression for the incident ASCVD. Model 1 was adjusted for baseline measurements of age and gender. Model 2 additionally adjusted for risk factors shared between VA and ASCVD, measured at baseline, including ethnicity, smoking status, education level, Townsend index, family history of severe ASCVD, physical activity level, and comorbidities (depression, diabetes, hypertension, and hyperlipidemia).
T, tertiles of LogMAR value.
VA, visual acuity; ASCVD, atherosclerotic cardiovascular disease; HR, hazard ratio; LogMAR, logarithm of the minimum angle of resolution.
Figure 1
Mediation analysis for VA and ASCVD. Mediation analyses were performed for hypertension (panel A), diabetes (panel B), depression (panel C), and Townsend index (panel D) separately. Apart from the mediator being analyzed, other mediators were included as covariates to account for their potential influence on the mediator-outcome relationship. Additionally, the analysis adjusted for baseline measurements of age, gender, ethnicity, smoking status, education level, Townsend index, family history of severe ASCVD, physical activity level, and hyperlipidemia.
aP for indirect effect <0.05.
VA, visual acuity; ASCVD, atherosclerotic cardiovascular disease.
Figure 2
Mediation analysis of sex-specific for VA and ASCVD. For women, mediation analyses were performed for hypertension (panel A), diabetes (panel C), depression disorder (panel E) and Townsend index (panel G) separately. For men, mediation analyses were performed for hypertension (panel B), diabetes (panel D), depression (panel F), and Townsend index (panel H) separately. Apart from the mediator being analyzed, other mediators were included as covariates to account for their potential influence on the mediator-outcome relationship. Additionally, the analysis adjusted for baseline measurements of age, gender, ethnicity, smoking status, education level, Townsend index, family history of severe ASCVD, physical activity level, and hyperlipidemia.
aP for indirect effect <0.05.
VA, visual acuity; ASCVD, atherosclerotic cardiovascular disease.