Association analysis of metabolic score for visceral fat with cardiovascular disease: a prospective cohort study based on the China health and retirement longitudinal study.

Background: Accumulation of visceral fat beyond normal levels is closely linked to the development of cardiovascular disease (CVD). The metabolic score for visceral fat (METS-VF), a novel composite indicator of intra-abdominal fat, has shown potential in predicting metabolic disorders, yet its long-term relationship with the incidence of CVD and its specific subtypes (heart disease and stroke) remains uncertain. Therefore, this study aims to explicitly evaluate the longitudinal association between METS-VF and the risk of CVD, heart disease, and stroke among a nationally representative middle-aged and older population in China. Methods: This prospective cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS). The national baseline survey was conducted between May 2011 and March 2012, initially involving 17,705 participants, with subsequent follow-up assessments in 2013, 2015, and concluding in August 2018. Participants aged ≥45 years were included, while those with prevalent CVD at baseline or missing key variables were excluded, resulting in a final sample of 6,501 participants for analysis. Multivariate Cox regression models were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). The nonlinear relationship was assessed through restricted cubic splines (RCS). Subgroup analyses of age and gender were undertaken, alongside sensitivity analyses using the Fine-Gray competitive risk model. Results: In the fully adjusted model, METS-VF was significantly and positively associated with the risk of CVD (HR =1.59, 95% CI: 1.38-1.83, P<0.001), heart disease (HR =1.49, 95% CI: 1.26-1.75, P<0.001), and stroke (HR =1.90, 95% CI: 1.47-2.45, P<0.001). Compared to the lowest quartile (Q1), the highest quartile (Q4, ≥7.05) of METS-VF showed a 77% increased risk of CVD (HR =1.77, 95% CI: 1.46-2.14, P<0.001). RCS analysis revealed no significant nonlinear relationship between METS-VF and CVD risk (P for nonlinear >0.05). Subgroup analysis revealed that age and gender did not exhibit significant interactive effects (P for interaction >0.05). Conclusions: METS-VF is positively linked with the risk of CVD among the middle-aged and older populations. This association remains stable across subgroups of individuals with smoking, hypertension, and diabetes status, as well as in individuals aged 45-74 years; however, no significant association was observed in individuals aged ≥75 years or in women with stroke risk. METS-VF, as a convenient and cost-effective tool for evaluating visceral fat, holds significant clinical application value in the early identification and risk stratification of CVD.