Association between Chinese Visceral Adiposity Index and cardiovascular events in patients with cardiovascular kidney-metabolic syndrome stages 0–3: a longitudinal analysis based on CHARLS

Background The Chinese Visceral Adiposity Index (CVAI) demonstrates a stronger association with metabolic diseases, cardiovascular diseases (CVD), and diabetic complications in Asian populations compared to other adiposity indices. However, the association of CVAI with cardiovascular events in cardiovascular-kidney-metabolic (CKM) syndrome stages 0–3 remain undetermined. Purpose To investigate the association between CVAI and cardiovascular events across CKM stages 0–3, and evaluate its predictive value versus traditional measures. Methods This prospective cohort study included 6,106 adults with CKM syndrome stages 0–3 from the China Health and Retirement Longitudinal Study (CHARLS). Logistic models were used to evaluate the associations between CVAI and cardiovascular events across different CKM stages, with cardiovascular disease as the primary outcome and coronary heart disease (CHD) or stroke as the secondary outcome. Results Over 7 years, 805 participants developed CVD, including 481 CHD events and 374 stroke events. In fully adjusted models, each SD increase in CVAI was associated with 33% higher CVD risk (OR 1.33, 95% CI 1.22-1.45), with graded increase across tertiles (T3 vs. T1: OR 1.86, 95% CI 1.50-2.32). This association strengthened with advancing CKM stage, becoming significant in stages 2–3. RCS analyses confirmed linear dose-response relationships (all P-nonlinearity >0.05). CVAI combined with traditional risk scores achieved highest predictive performance (ASCVD+CVAI AUC: 0.624; FRS+CVAI AUC: 0.624) and outperformed other adiposity indices (CVAI AUC: 0.617). Trajectory analysis revealed that a rapidly rising CVAI pattern was associated with a 72-121% higher CVD risk versus a stable pattern. Conclusions CVAI is a robust, independent predictor of cardiovascular risk in early-stage CKM syndrome, with particular relevance in stages 2–3. CVAI outperforms conventional indices, enhances established risk scores, and reflects dynamic risk progression, supporting its potential utility for refined risk stratification and timely intervention in this high-risk population.