Key result
Highest Chinese visceral adiposity index linked to ~126% higher CVD risk in early CKM stages.
Why the study?
The impact of visceral adiposity in early CKM syndrome and its possible mediation through arterial stiffness were not well clarified.
Does higher visceral fat accumulation increase the risk of incident CVD in adults at CKM stages 0-3?
Cohort (n=6,715)
Yes
Does higher visceral fat accumulation increase the risk of incident CVD in adults at CKM stages 0-3?
Visceral fat accumulation, particularly measured by CVAI, is significantly associated with increased CVD risk in early CKM stages, an effect partially mediated by arterial stiffness.
Answers are grounded in this paper and cite their sources.
Supports CVAI-guided risk stratification in early CKM; extends visceral adiposity evidence but leaves open benefits of targeted reduction.
Cardiovascular-kidney-metabolic (CKM) syndrome reflects the interaction of metabolic disorders with organ dysfunction. Cardiovascular disease (CVD) is a common consequence. Visceral adiposity is an important contributor to this pathway, but its impact in early CKM and the possible mediation through arterial stiffness are not well clarified. A total of 6,715 Chinese adults (≥ 45 years) at CKM stages 0–3 was selected from the China Health and Retirement Longitudinal Study. Using Cox proportional hazards regression together with restricted cubic spline (RCS) models, this nationwide prospective cohort study investigated the links between CVD and six visceral fat indices, namely triglyceride-glucose waist-to-height ratio (TyG-WHtR), relative fat mass (RFM), weight-adjusted waist index (WWI), conicity index (CI), body roundness index (BRI), and Chinese visceral adiposity index (CVAI). Causal mediation analysis was applied to evaluate the potential mediation by arterial stiffness, as reflected by estimated pulse wave velocity (ePWV). Subgroup and sensitivity analyses were conducted to confirm the stability of the results. Across the 9-year follow-up, 1,606 individuals developed new-onset CVD. In the model with full adjustment, RFM (HR = 1.46, 95% CI: 1.31–1.62) exhibited the strongest associations. The highest quartiles of CVAI and TyG-WHtR were associated with significantly increased CVD risk, with HRs of 2.26 (95% CI: 1.95–2.62) and 1.81 (95% CI: 1.56–2.11), respectively. In RCS analysis, TyG-WHtR, RFM, WWI, BRI and CVAI showed linear associations, while CI exhibited nonlinear patterns. ePWV partially mediated these associations, accounting for 12.18–22.14% of the total effect. The results were consistent in subgroup and sensitivity analyses. These results demonstrate a significant association between six visceral fat indices and CVD risk, which is partially mediated by arterial stiffness, highlighting the potential of these indices, particularly CVAI, to serve as accessible biomarkers for early CVD detection among individuals at CKM stages 0–3.
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Wang et al. (2026) conducted a cohort in Cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 (n=6,715). Visceral fat indices (e.g., CVAI, RFM, TyG-WHtR) vs. Lowest quartile of visceral fat indices was evaluated on Incidence of cardiovascular disease (CKM stage 4) (HR 2.26, 95% CI 1.95-2.62). The highest quartile of the Chinese visceral adiposity index was associated with a 2.26-fold increased risk of incident cardiovascular disease in adults at early cardiovascular-kidney-metabolic stages.
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