What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Carotid atherosclerosis (n=6767). Intervention: Chinese Visceral Adiposity Index (CVAI) vs. Lower CVAI. Primary outcome: Carotid atherosclerosis (CAS) (OR 1.37, 95% CI 1.26-1.49, p=<0.001).

What question did this study set out to answer?

This study aims to explore the mediating roles of fasting plasma glucose and systolic blood pressure in the relationship between the Chinese visceral adiposity index and carotid atherosclerosis.

April 4, 2026Open Access

The mediating role of fasting plasma glucose and systolic blood pressure in the association between Chinese visceral adiposity index and carotid atherosclerosis: a cross-sectional study

Q: What are the key findings of this study?

Each standard deviation increase in the Chinese Visceral Adiposity Index was associated with 37% higher odds of carotid atherosclerosis, with SBP and FPG mediating 59.2% of the total effect.

Q: What question did this study set out to answer?

This study aims to explore the mediating roles of fasting plasma glucose and systolic blood pressure in the relationship between the Chinese visceral adiposity index and carotid atherosclerosis.

Key Result

Each standard deviation increase in the Chinese Visceral Adiposity Index was associated with 37% higher odds of carotid atherosclerosis, with SBP and FPG mediating 59.2% of the total effect.

Key Points

This study aims to explore the mediating roles of fasting plasma glucose and systolic blood pressure in the relationship between the Chinese visceral adiposity index and carotid atherosclerosis.
Conducted a cross-sectional analysis involving 6767 adults from a general health check-up population in Shanghai.
Utilized parallel mediation analysis to examine the interrelation among CVAI, fasting plasma glucose, systolic blood pressure, and carotid atherosclerosis.
Adjusted for potential confounding variables to ensure robust results.
Each standard deviation increase in CVAI was associated with a 37% increase in the odds of carotid atherosclerosis.
Systolic blood pressure and fasting plasma glucose accounted for 59.2% of the total effect of CVAI on carotid atherosclerosis.
A significant direct effect of CVAI on carotid atherosclerosis remained at 40.8%.

Study Design

Type

Cross-Sectional (n=6,767)

Structured PICO

Does a higher Chinese Visceral Adiposity Index (CVAI) increase the risk of carotid atherosclerosis, and is this association mediated by fasting plasma glucose and systolic blood pressure?

Population

6,767 adults (median age 47, 68.8% male) from a general health check-up population in Shanghai. Key inclusion: age ≥ 18 years, complete demographic/clinical variables, and high-quality carotid ultrasound. Key exclusion: history of major surgery, significant cardiopulmonary, hepatic, or renal diseases.

Intervention

Higher Chinese Visceral Adiposity Index (CVAI) score (analyzed continuously per standard deviation increase and by tertiles)

Comparator

Lower CVAI score (lowest tertile Q1: CVAI ≤ 67.35)

Outcome

Carotid atherosclerosis (CAS), defined as carotid intima-media thickness (cIMT) > 0.9 mm and/or presence of carotid plaque assessed by ultrasoundsurrogate

Higher visceral adiposity, as measured by the CVAI, is significantly associated with increased carotid atherosclerosis risk, a relationship largely mediated by elevated systolic blood pressure and fasting plasma glucose.

Main Result

Effect estimate: OR 1.37 (95% CI 1.26-1.49)

p-value: p=<0.001

Limitations

Cross-sectional design precludes inferences regarding causality
Potential residual confounding from unmeasured factors like detailed dietary patterns and physical activity levels
Participants were primarily from a non-manual labor population undergoing health check-ups, limiting generalizability

Abstract

Visceral adipose tissue dysfunction is a key driver of cardiometabolic disease, yet the pathways linking it to atherosclerosis remain incompletely understood. This cross-sectional study included 6767 adults from a general health check-up population in Shanghai and investigated the association between the Chinese Visceral Adiposity Index (CVAI) and carotid atherosclerosis (CAS), as well as the mediating roles of systolic blood pressure (SBP) and fasting plasma glucose (FPG) using parallel mediation analysis. After full adjustment for confounders, each standard deviation (SD) increase in CVAI was associated with 37% higher odds of CAS (OR 1.37, 95% CI 1.26–1.49), demonstrating a significant linear dose-response relationship (P-overall 0.05). This study quantifies the substantial parallel mediating roles of SBP and FPG in the CVAI–CAS association, highlighting the potential relevance of blood pressure and glycemic pathways in linking visceral adiposity to atherosclerosis risk.

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