Cardiovascular Risk and Eye Health: A Cohort Study of the Pooled Cohort Equations and Ocular Disease Incidence

We assessed whether the Pooled Cohort Equations (PCE) cardiovascular risk score, used in primary care, is associated with the future age-related macular degeneration (AMD), glaucoma, diabetic retinopathy (DR), retinal vein occlusion (RVO), and hypertensive retinopathy (HTR).

Retrospective cohort study.

We used electronic health record data from the All of Us (AoU) Research Program. Participants aged 40 to 79 years had to have complete variables for PCE calculation within a 6-month period between 2009 and 2015. We excluded participants with preexisting atherosclerotic cardiovascular disease or any of the 5 ocular diseases before the baseline PCE period. A total of 35 909 adults were included in this study.

Individual-level PCE score was computed and categorized into 4 PCE risk categories: low (<5%), borderline (5%-7.4%), intermediate (7.5%-19.9%), and high (≥20%). Time-to-event analyses included Kaplan-Meier curves and univariate and multivariable Cox proportional hazards regression models. The primary multivariable models adjusted for race, body mass index, chronic kidney disease, and education (not included in PCE to avoid overadjustment). Concordance index (C-index) was reported to assess model performance. Sensitivity analyses tested varied follow-up durations (5, 6, and 7 years) and, in a prespecified component-adjustment sensitivity set, sequentially added PCE components (age, smoking, diabetes).

Diagnoses of AMD, glaucoma, DR, RVO, or HTR.

Higher PCE risk categories were significantly associated with increased risk of ocular diseases. In the primary models, compared with the low-risk group, the high-risk group had the highest hazard ratios for AMD (6.22), DR (5.93), glaucoma (2.33), RVO (3.38), and HTR (4.47) (all P < 0.001). Adjusted C-indices were highest for AMD (0.72), DR (0.751), and HTR (0.768), and moderate for glaucoma (0.625) and RVO (0.654). Findings were consistent in different follow-up periods. In component-adjustment sensitivity models, PCE-AMD association was largely explained by age, whereas associations for DR and HTR remained robust.

In the AoU population, the single composite metric PCE meaningfully stratifies future risk for multiple ocular diseases, using information already available in primary care. This suggests PCE could be incorporated into primary care settings to identify individuals who would benefit from earlier ophthalmologic evaluation and prevention strategies.

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