Metabolism score for visceral fat (METS-VF): an innovative and powerful predictor of stroke

Cardiovascular disease (CVD) is a common clinical disease threatening human health, particularly among middle-aged and older individuals. It is characterized by high morbidity, high disability, and high mortality. CVD is a significant contributor to mortality, ranking among the leading causes of death 1. In low-and middle-income countries, the average month-to-month treatment cost of stroke and coronary heart disease is between 300 and 1000 2. Therefore, formulating effective public health strategies to reduce the prevalence of cardiovascular diseases is of great significance for reducing the social and economic burden. Visceral fat content is widely documented to be significantly linked to the advancement of cardiovascular disease 3. Metabolic score for visceral fat (METS-VF) is a new visceral fat prediction index created by Mexican scholars in the past 2 years. It is constructed by indicators such as gender, age, height, weight, waist circumference, fast glucose, cholesterol: high-density lipoprotein cholesterol (HDL-c), etc. 4, and performs better than other synthetic visual fat indexes (VFI). Moreover, previous studies have confirmed that METS-VF has good prediction efficiency in predicting hypertension 5 and type 2 diabetes mellitus 6. METS-VF may be strongly linked to cardiovascular events. This study aims to establish a prospective cohort study using the China Health and Retirement Longitudinal Study (CHARLS) to examine the association between METS-VF and CVD, as well as the mediation role of triglycerides (TG) in the above relationship, and to visualize the results by building a decision tree model, ultimately providing insights for reducing the incidence of CVD. Methods. Study population: We used data from waves 1 to 4 (2011-2012 to 2018) of CHARLS survey, with wave 1 as the baseline. The survey covered 28 provinces (autonomous regions and municipalities) and 450 villages/communities, with a sample of 19, 000 participants from 124, 000 homes as of its completion in 2018. Of the 2011 baseline survey participants, 17, 707 completed baseline physical examinations and questionnaire surveys. Among these participants, blood data were available for 11, 847 individuals. A total of 13, 145 participants were excluded based on the following specific criteria: age younger than 45 years old (n = 423), history of taking lipid-lowering and hypoglyce-