The role of visceral obesity surrogate markers in predicting cardiovascular disease: Insights from the CHARLS study

Cardiovascular disease (CVD) has been a major cause of morbidity and mortality in the world, accounting for approximately one-third of all deaths worldwide. Early detection of risk factors and effective preventive measures are crucial for reducing the impact of cardiovascular and cerebrovascular diseases on public health. We conducted a retrospective analysis of data from the China Health and Retirement Longitudinal Study between 2011 and 2018. Logistic regression and restricted cubic spline modeling were used for analysis. Moreover, the area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (CI) was calculated to assess the predictive power of Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), metabolic score for visceral fat (METS-VF), triglyceride-glucose (TyG), and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) for risk of CVD. CVAI and METS-VF were significantly associated with CVD risk, with odds ratios calculated per 1 standard deviation (CVAI: odds ratio OR = 1.16, 95% CI 1.05–1.29; METS-VF: OR = 1.11, 95% CI 1.01–1.23). LAP (Q3: OR = 1.39, 95% CI 1.11–1.73) and TG/HDL-C ratio (Q3: OR = 1.31, 95% CI 1.08–1.59) showed significant associations with increased CVD risk. For discrimination, CVAI showed the highest AUC values, 0.5767 (0.5560–0.5974) for HD, 0.6123 (0.5873–0.6373) for stroke, 0.5910 (0.5726–0.6093) for CVD, respectively. CVAI and METS-VF were positively associated with CVD risk and showed slightly better discrimination than other adiposity-related indices. These findings suggest that visceral adiposity and dyslipidemia remain important correlates of cardiovascular and cerebrovascular risk and may inform prevention strategies when considered alongside established risk factors.