This article is from WeChat public account: Qídiǎn Network, author: Dai Siyu. Original title: "JACC: The eye is truly a 'window' to heart health — Data from 2.52 million Chinese older adults reveal poor vision linked to 30% higher cardiovascular death risk"

In clinical medicine, we are accustomed to assessing cardiovascular health through sphygmomanometers, glucometers, or complex imaging examinations.

But have you ever considered that the most ordinary eye chart hanging on the wall might hold the key to predicting heart health?

Previous research has noted an association between visual impairment and all-cause mortality, but the link with heart health remained unclear.

Recently, the Journal of the American College of Cardiology (JACC) published a study from the Chinese CDC team.

Analyzing data from nearly 2.52 million older adults aged 65 and above, the researchers found that visual impairment is independently associated with a significantly increased risk of cardiovascular death.

Compared with the quartile with the best vision, the group with the worst vision had a 30% higher risk of cardiovascular death.

The study data came from the Basic Public Health Service (BPHS) cohorts in four cities: Zaozhuang, Luzhou, Zunyi, and Shenzhen, covering 2,517,662 older adults aged ≥65 years.

Presenting visual acuity in daily living conditions was measured using a standard logarithmic eye chart, primarily referring to the better eye's vision, and converted into logMAR units for analysis.

A higher logMAR value indicates worse vision.

Each one-unit increase in logMAR corresponds to a tenfold decrease in visual clarity, equivalent to a 1-point drop in the commonly used 5-point Chinese vision scale.

Among the nearly 2.52 million older participants, 42.5% had visual impairment, highlighting that declining vision is a common physical decline in the elderly.

Over a median follow-up of 4.99 years, the study documented 348,501 deaths, including 153,758 cardiovascular deaths.

Analysis showed that for each 1-logMAR increase in vision, all-cause mortality risk increased by 3%, and cardiovascular mortality risk increased by 3%.

When vision was divided into quartiles, compared with the best vision group, the worst vision group had a 25% higher all-cause mortality risk and a 30% higher cardiovascular mortality risk.

Among people aged 65-70, the association between visual impairment and mortality risk was strongest.

Additionally, the researchers observed a steeper increase in mortality risk during the mild vision impairment stage.

Interestingly, visual impairment showed almost no significant association with cancer mortality.

This difference strongly supports the specificity of vision as a cardiovascular-specific indicator rather than a general marker of aging.

What is the connection between the eyes and the heart?

The researchers proposed the concept of Oculomics.

First, the microvascular network of the retina is highly similar in embryonic development and physiological characteristics to the coronary and cerebral circulations.

A decline in vision often预示着 systemic microcirculatory dysfunction, endothelial damage, and chronic inflammation accumulation.

Second, visual impairment triggers a cascade of consequences: reduced physical activity, social isolation, increased psychological stress, and cognitive impairment in older adults.

These negative factors intertwine and further weaken cardiovascular physiological reserve.

The researchers point out that visual impairment should be regarded as an alarm for cardiovascular risk.

Deep integration of vision screening into basic medical services for the elderly is necessary.

Moreover, older adults with poor vision face more challenges in medication adherence, fall prevention, and cardiovascular rehabilitation training.

Healthcare systems should provide better communication methods and more comprehensive family support to achieve the goal of prolonging healthy life expectancy.

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References:
[1] Li,Y., Yan,F., Yu,L., Xu,J., Wu,T., Cao,J., Zhang,Y., Wang,L., Zhou,M., & Yin,P.(2026). Visual acuity and cardiovascular mortality in 2.52 million older adults in China. Journal of the American College of Cardiology. Advance online publication. https://doi.org/10.1016/j.jacc.2026.02.511