Causal Relationship between Television Viewing Time, Cardiovascular Diseases, and Potential Mechanisms

Hu, Mengjin; Li, Boyu; Xia, Jinggang; Yin, Chunlin; Yang, Yuejin

doi:10.36660/abc.20230796

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Original Article • Arq. Bras. Cardiol. 121 (10) • 2024 • https://doi.org/10.36660/abc.20230796i linkcopy

Causal Relationship between Television Viewing Time, Cardiovascular Diseases, and Potential Mechanisms

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Background: As the predominant leisure-time sedentary behavior, television viewing was documented to increase cardiovascular diseases in observational studies, yet the causal relationship and potential mechanisms remain to be determined.

Objectives: To systematically investigate the causal relationship between television viewing time, cardiovascular diseases, and potential mechanisms.

Methods: We conducted a two-sample Mendelian randomization (MR) analysis to estimate causal associations with cardiovascular diseases and biomarkers of cardiometabolic risk. The random inverse-variance weighted method was used as the primary estimate. To account for multiple comparisons, a Bonferroni correction p value for cardiovascular diseases and biomarkers of cardiometabolic risk was 0.0045 and 0.0024, respectively.

Results: Genetically instrumented television viewing time was associated with higher risks of type 2 diabetes (odd ratio [OR]=2.51; 95% confidence interval [CI]: 1.89-3.33; p<0.00001), hypertension (OR=2.11; 95% CI: 1.67-2.66; p<0.00001), coronary heart disease (OR=1.53; 95% CI: 1.23-1.91; p=0.00015), and heart failure (OR=1.42; 95% CI: 1.18-1.70; p=0.00017). Suggestive evidence of harmful associations was also observed for peripheral artery disease (OR=1.58; 95% CI: 1.07-2.34; p=0.02253) and ischemic stroke (OR=1.34; 95% CI: 1.10-1.63; p=0.00328). Biomarkers of cardiometabolic risk, including interleukin 10, leptin, visceral adipose, abdominal subcutaneous adipose, liver fat, body mass index, waist circumference, triglycerides, and C-reactive protein, were increased. Systolic blood pressure, heart rate, low-density lipoprotein, and total cholesterol were potentially increased while high-density lipoprotein was decreased. However, television viewing time had no effect on venous thromboembolism or pulmonary embolism.

Conclusion: Television viewing time was causally associated with increased risks of cardiovascular diseases, which may be explained by metabolic and inflammatory mechanisms.

Keywords:
Television; Cardiovascular Diseases; Cardiometabolic Risk Factors; Inflammation; Mendelian Randomization Analysis

Outcomes	Weighted median		MR-Egger		Heterogeneity		Pleiotropy
Outcomes	OR (95% CI)	p	OR (95% CI)	p	Q	p	Intercept	p
Coronary heart disease	1.52 (1.17-1.97)	0.00170	1.66 (0.61-4.52)	0.32058	167	<0.01	-0.001	0.87
Hypertension	2.00 (1.51-2.65)	<0.00001	1.23 (0.40-3.85)	0.71801	174	<0.01	0.0063	0.35
Atrial fibrillation	1.57 (0.88-2.81)	0.12969	1.19 (0.16-8.75)	0.86696	130	0.04	0.0011	0.92
Heart failure	1.57 (1.25-1.98)	0.00011	1.39 (0.60-3.18)	0.44250	143	<0.01	0.0003	0.96
Type 2 diabetes	2.43 (1.86-3.18)	<0.00001	5.73 (1.15-28.57)	0.03624	250	<0.01	-0.0095	0.31
Ischemic stroke	1.41 (1.12-1.79)	0.00385	2.06 (0.85-5.01)	0.11479	164	<0.01	-0.0051	0.34
Transient ischemic attack	1.13 (0.72-1.77)	0.60293	4.21 (0.87-20.38)	0.07683	115	0.21	-0.0134	0.15
Venous thromboembolism	0.88 (0.56-1.39)	0.59302	1.16 (0.19-7.09)	0.87435	155	<0.01	-0.0035	0.74
Pulmonary embolism	0.79 (0.42-1.47)	0.45391	2.74 (0.20-38.07)	0.45398	159	<0.01	-0.0156	0.31
Peripheral artery disease	1.52 (0.90-2.56)	0.11353	2.49 (0.36-17.29)	0.35698	131	0.04	-0.0054	0.64
Cardiac death	1.31 (0.78-2.20)	0.31031	1.35 (0.23-8.01)	0.73906	109	0.36	-0.0016	0.88

Outcomes	Weighted median		RM-Egger		Heterogeneity		Pleiotropy
Outcomes	Beta (95% CI)	p	Beta (95% CI)	p	Q	p	Intercept	p
Systolic blood pressure	1.69 (0.64. 2.74)	0.00163	-4.56 (-11.48. 2.36)	0.19992	741	<0.01	0.0765	0.06
Diastolic blood pressure	1.23 (0.63. 1.83)	0.00006	-1.91 (-6.63. 2.81)	0.42931	1026	<0.01	0.0352	0.21
Heart rate	1.10 (-0.97. 3.17)	0.29726	-2.06 (-9.65. 5.54)	0.59814	42	0.56	0.0407	0.35
Body mass index	0.22 (0.06. 0.39)	0.00686	1.17 (0.31. 2.03)	0.01098	133	<0.01	-0.0093	0.06
Visceral adipose	0.63 (0.44. 0.81)	<0.00001	0.81 (0.18. 1.44)	0.01289	149	0.01	-0.0028	0.46
Abdominal subcutaneous adipose	0.48 (0.27. 0.69)	0.00001	0.65 (-0.09. 1.39)	0.08797	174	<0.01	-0.0013	0.76
Liver fat	0.34 (0.13. 0.54)	0.00134	0.56 (-0.46. 1.57)	0.28591	285	<0.01	-0.0014	0.81
Leptin	0.63 (-0.05. 1.32)	0.07082	2.54 (-1.40. 6.49)	0.33364	1	0.8	-0.0276	0.46
Waist circumference	0.21 (0.02. 0.40)	0.03374	0.55 (-0.29. 1.39)	0.20845	85	<0.01	-0.0024	0.62
C-Reactive protein	0.36 (0.19. 0.53)	0.00002	0.27 (-0.57. 1.10)	0.53739	104	<0.01	0.0003	0.94
Interleukin 6	-0.21 (-1.05. 0.62)	0.61895	-1.84 (-4.69. 1.02)	0.21138	88	0.18	0.0240	0.17
Interleukin 10	2.32 (-0.77. 5.42)	0.14130	6.11 (-6.85. 19.07)	0.37353	5	0.97	-0.0407	0.57
Adiponectin	0.19 (-0.01. 0.39)	0.06947	0.94 (0.17. 1.71)	0.02056	68	0.01	-0.0092	0.04
Transforming growth factor-β	-0.09 (-1.43. 1.26)	0.89742	-1.65 (-5.70. 2.41)	0.42775	98	0.50	0.0153	0.52
Tumor necrosis factor-α	0.26 (-3.04. 3.56)	0.87779	-0.31 (-13.35. 12.73)	0.96397	12	0.52	-0.0038	0.96
Total cholesterol	0.22 (-0.04. 0.47)	0.09477	-1.80 (-3.14. −0.46)	0.01174	173	<0.01	0.0240	<0.01
Triglycerides	0.22 (0.02. 0.42)	0.02895	0.70 (-0.21. 1.62)	0.14147	79	<0.01	-0.0046	0.39
High-density lipoprotein	-0.17 (-0.40. 0.06)	0.14656	-2.44 (-3.58. −1.30)	0.00015	157	<0.01	0.0249	<0.01
Low-density lipoprotein	0.13 (-0.11. 0.37)	0.27773	-1.09 (-2.49. 0.31)	0.13381	161	<0.01	0.0166	0.04
Fasting glucose	0.01 (-0.13. 0.15)	0.92310	-0.06 (-0.51. 0.39)	0.80228	38	0.68	0.0007	0.78
Fibrinogen	0.49 (0.18. 0.79)	0.00206	0.75 (-0.23. 1.73)	0.15503	45	<0.01	-0.0062	0.35

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[TFN2] CI: confidence interval; MR: Mendelian randomization; OR: odd ratio.