Your Heart Risk Score May Predict Your Future Eye Health

Adobe Stock/Prostock-studio

A standard heart disease risk score, called the Pooled Cohort Equations (PCE), may also help predict who is at higher risk for serious eye diseases, according to research published in Ophthalmology.

Doctors routinely use PCE to estimate a person’s risk of developing heart disease or stroke over the next 10 years. This score is based on familiar factors such as age, blood pressure, cholesterol levels, diabetes status and smoking history. Until now, the PCE has been used almost exclusively to guide cardiovascular care. This new study asked an important question: Can the same heart risk score also predict future eye disease?

To find out, investigators analyzed electronic health records from more than 35,000 adults aged 40 to 79 who participated in the National Institutes of Health’s All of Us (AoU) Research Program. None of the participants had known heart disease or major eye diseases at the start of the study.

Each person’s PCE score was calculated and grouped into low (less than 5%), borderline (5%-7.4%), intermediate (7.5%-19.9%), or high (at least 20%) cardiovascular risk. The team then followed participants over time to see who developed common eye conditions, including age-related macular degeneration (AMD), glaucoma, diabetic retinopathy, retinal vein occlusion and hypertensive retinopathy.

The results were striking. People with higher PCE scores (meaning higher predicted heart risk) were much more likely to develop eye disease later on. Compared with those in the low-risk group, individuals in the high-risk group had more than six times the risk of developing macular degeneration, nearly six times the risk of diabetic retinopathy, and substantially higher risks of glaucoma, retinal vein occlusion and hypertensive retinopathy.

Importantly, these findings held up even after researchers adjusted for other factors such as race, body weight, kidney disease and education level. While age explained much of the connection between heart risk and macular degeneration, the links between PCE risk and diabetic and hypertensive eye disease remained strong, suggesting shared underlying damage to blood vessels throughout the body, including those in the eyes.

What this means for patients is simple but powerful: The same risk factors that harm the heart can also harm vision. Because PCE scores are already calculated in many primary care visits, this tool could help doctors identify people who may benefit from earlier or more frequent eye exams, even before symptoms appear. Earlier detection could lead to better prevention, earlier treatment and potentially preserved vision.

Investigators said the study’s strengths include the use of a large, ethnically diverse cohort from the AoU database, which improves how broadly the findings may apply, and a time-to-event design that allowed researchers to examine how cardiovascular risk predicts future eye disease over time. Robust statistical methods, including multivariable models and multiple sensitivity analyses, further strengthen the reliability of the results.

However, the PCE score was less accurate for predicting glaucoma and retinal vein occlusion, likely because key eye-specific factors, such as intraocular pressure for glaucoma, and smaller sample sizes were not fully accounted for. In addition, because PCE was designed for adults aged 40 to 79 without existing cardiovascular disease, the findings may not apply to younger individuals or those with known heart disease, highlighting the need for future studies using alternative risk scores and additional eye-specific data

“We found that a simple score already calculated in millions of doctor visits each year may meaningfully predict who will develop serious eye diseases,” said Anne L. Coleman, M.D., Ph.D., senior investigator of the study and chair of the Department of Ophthalmology at the University of California, Los Angeles Health. “This gives us an opportunity to identify high-risk patients early, when preventive measures might still protect their vision. The beauty of this approach is that it requires no additional testing; the information is already there in the medical record.”