Association between Chinese visceral adiposity index and heart failure in diabetic patients

Aims This study aimed to investigate the association between Chinese visceral adiposity index ( CVAI ) and heart failure ( HF ) risk in diabetic individuals and to evaluate the predictive capability of CVAI compared to other obesity metrics. Materials and Methods A prospective cohort study (Kailuan Study) spanning 2006 to 2022 involved 12 243 diabetic patients. Participants were stratified into CVAI quartiles ( Q1 : <96.13, n = 3060; Q2 : 96.13 to <121.25, n = 3061; Q3 : 121.25 to <146.85, n = 3061; Q4 : ≥146.85, n = 3061). The relationship between CVAI and HF occurrence was assessed using the Kaplan–Meier analysis and Cox regression models, supplemented by sensitivity analyses. Restricted cubic splines were used to evaluate potential nonlinear associations. Subgroup analyses examined the influence of sociodemographic factors and health behaviours. Receiver operating characteristic ( ROC ) analysis compared CVAI with other obesity indices. Statistical significance was set at p < 0.05. Results Over a median follow‐up of 15 years, 861 new HF cases were recorded. HF incidence rose with increasing CVAI quartiles ( Q1 – Q4 : 3.05–7.20/1000 person‐years; p < 0.05). Adjusted HRs (95% CI ) for HF in Q2 – Q4 compared to Q1 were 1.32 (1.06–1.65), 1.41 (1.13–1.75) and 1.91 (1.55–2.35) ( P trend < 0.01). Age significantly modified the CVAI ‐ HF relationship (≥60 years: HR = 2.06, 1.60–2.64; P interaction <0.01). CVAI exhibited a linear correlation with HF ( P nonlinear = 0.75) and demonstrated superior ROC ‐predictive accuracy compared to other indices ( p < 0.01). Conclusion CVAI is independently associated with HF risk, especially in elderly patients, supporting its utility for visceral fat‐related risk stratification.