Association between cardiovascular health assessed by Life's Essential 8 and diabetic retinopathy: The mediating role of phenotypic age and biological age

BACKGROUND: The American Heart Association (AHA) recently updated the Life's Essential 8 (LE8) metrics to measure ideal cardiovascular health (CVH). Diabetic retinopathy (DR) is the leading cause of vision impairment, exhibiting a rising prevalence globally. However, the association between LE8 and DR, as well as the mediating role of phenotypic age (PA) and biological age (BA), is still unclear. METHODS: LE8 scores were categorized into three groups: low (0-49), moderate (50-74), and high (75-100). PA and BA were computed using validated algorithms incorporating clinical biomarkers. Weighted logistic regression and linear analysis were employed to assess the relationship between LE8 and DR. The mediation analysis was conducted to explore the mediating role of PA and BA. RESULTS: Our study included 1129 participants with non-DR and 329 participants with DR from the National Health and Nutrition Examination Survey (NHANES). Higher LE8 scores were inversely associated with DR prevalence after adjusting for all covariates (OR = 0.24; 95% CI: 0.11-0.50; P for trend < 0.001). Each 10-point LE8 increase was related to a 23% decrease of DR (OR = 0.77, 95% CI: 0.69-0.84). Mediation analysis indicated that PA and BA partially mediated 35.61% and 46.38% of the association between LE8 and DR, respectively. CONCLUSIONS: The LE8 scores were negatively associated with the incidence of DR, while PA and BA partially mediated the association between LE8 scores and DR.