In a nationwide cohort of more than 2.5 million Chinese adults aged 65 years or older, visual acuity (VA) impairment was highly prevalent and independently associated with increased risk of mortality from any cause and from cardiovascular disease, according to a large-scale study published April 15 in JACC.

Leveraging data from the Basic Public Health Services program in China, this multicenter cohort study quantified the burden of VA impairment and examined its association with cardiovascular disease-related mortality across four geographically diverse cities in China between 2017 and 2023.

Presenting visual acuity of the better-seeing eye (BVA) was measured using a standard logarithmic tumbling E chart, and mortality data were collected via linkage to the China Population Death Information Registration System, with follow-up through December 31, 2024. Yanlong Li, MM, et al., used Cox proportional hazards models to estimate hazard ratios (HRs).

Over a five-year follow-up, researchers found that 43% of participants experienced VA impairment. After comprehensive adjustment for demographic, lifestyle, clinical and geographic covariates, worsening VA (per 1-logMAR increase) was independently associated with a 3% increase in both all-cause and cardiovascular disease mortality.

Quartile-based analyses demonstrated a dose-dependent relationship, with individuals in the worst VA quartile experiencing substantially elevated risks of all-cause death (HR, 1.25; 95% CI, 1.24-1.26) and cardiovascular disease-related death (HR, 1.30; 95% CI, 1.28-1.32) compared with those in the best quartile.

Notably, nonlinear dose-response modeling revealed a steeper increase in mortality risk at lower levels of impairment and plateauing at higher levels. Additionally, the association was more pronounced among younger participants (65-70 years).

The authors write that their findings "reframe VA beyond its traditional ocular role, positioning it as a readily observable functional signal of cardiovascular vulnerability." This perspective may prompt physicians to situate "cardiovascular risk within the broader landscape of functional aging, moving beyond reliance solely on traditional risk factors."