Cardiovascular Disease Risk Factors in US Adults With Vision Impairment

Isabel Mendez, MS; Minchul Kim, PhD; Elizabeth A. Lundeen, PhD; Fleetwood Loustalot, PhD, FNP; Jing Fang, MD, MS; Jinan Saaddine, MD, MPH


Prev Chronic Dis. 2022;19(7):e43 

In This Article

Abstract and Introduction


Introduction: Adults with vision impairment (VI) have a higher prevalence of cardiovascular disease (CVD) compared with those without VI. We estimated the prevalence of CVD and CVD risk factors by VI status in US adults.

Methods: We used nationally representative data from the 2018 National Health Interview Survey (N = 22,890 adults aged ≥18 years). We estimated the prevalence of self-reported diagnosis of CVD (coronary heart disease [including angina and myocardial infarction], stroke, or other heart disease) by VI status. We used separate logistic regression models to generate adjusted prevalence ratios (aPRs), controlling for sociodemographic covariates, for those with VI (reference group, no VI) for CVD and CVD risk factors: current smoking, physical inactivity, excessive alcohol intake, obesity, hypertension, high cholesterol, and diabetes.

Results: Overall, 12.9% (95% CI, 12.3–13.5) of the sample had VI. The prevalence of CVD was 26.6% (95% CI, 24.7–28.6) in people with VI versus 12.2% (95% CI, 11.7–12.8) in those without VI (aPR = 1.65 [95% CI, 1.51–1.80]). Compared with adults without VI, those with VI had a higher prevalence of all risk factors examined: current smoking (aPR = 1.40 [95% CI, 1.27–1.53]), physical inactivity (aPR = 1.14 [95% CI, 1.06–1.22]), excessive alcohol intake (aPR = 1.29 [95% CI, 1.08–1.53]), obesity (aPR = 1.28 [95% CI, 1.21–1.36]), hypertension (aPR = 1.29 [95% CI, 1.22–1.36]), high cholesterol (aPR = 1.21 [95% CI, 1.14–1.29]), and diabetes (aPR = 1.54 [95% CI, 1.38–1.72]).

Conclusion: Adults with VI had a higher prevalence of CVD and CVD risk factors compared with those without VI. Effective clinical and lifestyle interventions, adapted to accommodate VI-related challenges, may help reduce CVD risk in adults with VI.


Cardiovascular disease (CVD), including heart disease, stroke and vascular disease, is a major cause of illness and death in the US, claiming 800,000 lives each year.[1] CVD contributes $363 billion annually in health care costs and lost productivity.[1]

CVD can be prevented or delayed through lifestyle modifications to control or manage risk factors. Approximately 34% of deaths from heart disease could be prevented by modifying key risk factors.[2] The American Heart Association (AHA) promotes Life's Simple 7 (LS7),[3] which identifies and quantifies 7 factors that influence cardiovascular health (smoking status, physical activity, body weight, diet, blood pressure, cholesterol, and blood glucose), with higher LS7 scores associated with better cardiovascular health and lower risk of all-cause and CVD mortality.[1,4]

A strong connection between cardiovascular health and eye health has been noted;[5] they share risk factors such as older age, current smoking, high blood glucose, and hypertension. One study found that adults aged 40 years or older who had better cardiovascular health had lower odds of ocular diseases such as age-related macular degeneration (AMD), diabetic retinopathy, cataract, and glaucoma.[5] Research has also shown that compared with adults without vision impairment (VI), those with VI have a higher prevalence of CVD, contributing to increased mortality risk among the 7 million Americans with VI.[6,7] A study of US adults aged 65 years or older found that compared with people without VI, people with VI had a higher prevalence of 13 self-reported chronic conditions, including heart disease and stroke.[7]

Although studies have examined the relationship between VI and CVD,[7–9] less is known about differences in prevalence of CVD risk factors between people with and without VI. Better understanding the relationship between VI and CVD risk factors may aid in prevention and management of CVD among those with VI. Our objective was to assess the relationship between VI and CVD risk factors in US adults.