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Figure 1 | BioPsychoSocial Medicine

Figure 1

From: Is the association between optimistic cardiovascular risk perceptions and lower rates of cardiovascular disease mortality explained by biomarkers of systemic inflammation or endothelial function? A case-cohort study

Figure 1

Hypothetical sources of unmeasured confounding and adjustment for CRP and VEGF. E = Comparative optimism in heart disease risk. O = CVD death. C = Systemic inflammation/endothelial dysfunction. U = Unmeasured potential confounder (e.g. personality, mood) A Directed Acyclic Graph (DAG) is a useful methodological tool for considering bias and confounding in complex associations. The DAG shown above in Figure 1 graphically represents how measures of systemic inflammation and endothelial dysfunction, C, relate to a set of plausible, yet unmeasured psychological confounders, U (i.e. mood, self-rated health, and personality) of the relation between comparatively optimistic ratings of CVD risk, E, and CVD death, O. Under hypothetical conditions where unmeasured psychological factors contributed to substantial residual confounding, adjusting for C (as this study does) blocks major physiological pathways that would be responsible for such residual confounding by U.

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BioPsychoSocial Medicine

ISSN: 1751-0759

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