Phenotypic age and biological age mediate the association between Life's Essential 8 and diabetic retinopathy among US adults

Background Cardiovascular disease (CVD) is closely associated with Diabetic retinopathy (DR), and the prevalence of DR is steadily increasing. Life's Essential 8 (LE8), a recently updated assessment of cardiovascular health (CVH), was examined in this study to determine if it was related to diabetes among adults in the United States. Methods 316 DR participants and 2,314 non-DR participants were included in the analyses using data from the National Health and Nutrition Examination Survey (NHANES) database (2005–2018). LE8 scores, derived from eight individual metrics, were categorized into three groups: low (0–49), moderate (50–74), and high (75–100). Combining certain biomarker sets allowed for the measurement of both phenotypic age (PA) and biological age (BA). In order to evaluate the relationship between LE8 scores and DR, weighted logistic regression and linear analysis were used. The mediating function of PA and BA was investigated by mediation analysis. Results After adjusting for all covariates, higher LE8 scores were associated with a lower risk of DR (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.26–0.93; P for trend = 0.027). A 10-score increase in LE8 score was related to a 17% decrease in the risk of DR (multivariate-adjusted OR = 0.83, 95% CI: 0.73–0.95). Mediation analysis indicated that PA and BA partially mediated 47.57% and 28.11% of the association between LE8 scores and DR, respectively. Conclusion A negative association was found between LE8 scores and the presence of DR, possibly mediated by PA and BA. As a result of these findings, encouraging adherence to optimal CVH levels may be beneficial in reducing the prevalence of DR.