Association of metabolic score for visceral fat with the prevalence, new-onset, and progression of aortic valve calcification: evidence from a prospective observational study and genetic analyses

Obesity significantly influences aortic valve calcification (AVC). However, the relationship between Metabolic Score for Visceral Fat (METS-VF), an indicator of visceral adiposity, and AVC remains largely unclear. Therefore, this study investigated the correlations between METS-VF with AVC prevalence, new-onset, and progression, as well as the causal association between visceral adipose tissue (VAT) and calcific aortic valve stenosis (CAVS). The analysis included a cohort of 5,245 individuals drawn from the Multi-Ethnic Study of Atherosclerosis (MESA) database. Associations between baseline METS-VF and AVC prevalence, new-onset, and progression were analyzed through logistic regression and Cox regression. The potential causal link between the VAT and CAVS was evaluated by applying a two-sample Mendelian randomization (MR) strategy. The findings indicated that a one-unit increment in METS-VF correlates with a 41% increased risk of prevalent AVC in the fully adjusted model (odds ratio OR = 1.41; 95% confidence interval CI, 1.14–1.75; P = 0.002). After full adjustment in the multivariable regression analysis, a unit increase in METS-VF was correlated with a 79% higher possibility of AVC new-onset (hazard ratio HR = 1.79; 95% CI, 1.24–2.59; P = 0.002) and an 86% higher incident of AVC progression (HR = 1.86; 95% CI, 1.41–2.44; P < 0.001). Restricted cubic spline analysis revealed approximately linear relationships between METS-VF and AVC prevalence, new-onset, and progression. Subgroup analyses demonstrated consistent findings across groups, except for notable interactions by race (for AVC prevalence) and sex (for AVC new-onset). METS-VF outperformed other indices linked to anthropometric and metabolic characteristics in terms of predictive performance, based on receiver operating characteristic curves. Additionally, MR demonstrated that VAT had a strong causal effect on CAVS. METS-VF independently predicts AVC prevalence, new-onset, and progression, and MR analyses support VAT as a causal factor for incident CAVS. METS-VF might function as an efficient and budget-friendly screening method or early risk identification. Targeting visceral adiposity represents a promising primary prevention strategy against valvular heart disease.