Association between Cumulative Exposure to Metabolic Score for Visceral Fat and the risk of stroke in a population with cardiovascular-kidney-metabolic syndrome stages 0–3: a nationwide prospective cohort study

BACKGROUND AND AIM The association between cumulative exposure to METS-VF and the risk of stroke at cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 remains inadequately understood. This study aimed to investigate the association between cumulative METS-VF and incident stroke in this population. METHODS AND RESULTS This analysis was based on data from the China Health and Retirement Longitudinal Study (CHARLS), focusing on participants assigned to CKM syndrome stages 0-3. An optimal cut-off for time-averaged cumulative METS-VF in relation to stroke was identified through the survival-time method incorporating maximally selected rank statistics. We applied Cox proportional hazards regression models to examine the association between cumulative METS-VF and stroke risk. Over a five-year follow-up period, 235 of the 3227 participants experienced stroke. In participants with CKM syndrome stages 0-3, cumulative METS-VF showed a positive association with stroke risk. After adjustment for confounding variables in model 3, participants classified into Q2, Q3, and Q4 showed a significantly higher risk of stroke than those in Q1. These were 1.664 (1.070-2.588), 1.765 (1.145-2.719), and 2.261 (1.478-3.459) for the corresponding hazard ratios (HRs) and 95% confidence intervals (CIs). A cumulative average METS-VF level greater than 6.53 was associated with a significantly elevated risk of stroke relative to participants with values below 6.53 (HR = 1.781, 95% CI: 1.296-2.448). CONCLUSIONS Cumulative METS-VF is significantly associated with an increased risk of stroke. Among individuals with CKM stages 0-3, time-averaged assessment of longer-term METS-VF burden may help identify individuals at elevated risk of stroke, thereby providing supportive evidence for early preventive strategies.