Abstract：Objective To examine the association between visceral fat metabolic levels and cardiovascular disease (CVD) among middle-aged and elderly population, so as to provide the evidence for the early identification and prevention of CVD risk in this population. Methods Based on the database of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, baseline demographic information, lifestyle, disease history, and CVD status of participants aged ≥45 years were collected. Data on height, weight, waist circumference, and blood biochemical indicators from 2012 and 2015 were collected and used to calculate the metabolic score for visceral fat (METS-VF) and cumulative METS-VF, enabling an assessment of visceral fat metabolism levels. The K-means clustering algorithm was applied to analyze the categories of METS-VF. Multivariable logistic regression models were used to analyze the association between different METS-VF categories, cumulative METS-VF and CVD. A restricted cubic spline model was employed to examine the dose-response relationship between cumulative METS-VF and CVD. Results A total of 3 146 participants were included, with a median age of 57.00 (interquartile range, 12.00) years. There were 1 405 males (44.66%) and 1 741 females (55.34%). METS-VF was clustered into three distinct categories: a persistently low-level group, a persistently moderate-level group, and a persistently high-level group, comprising 497, 1 302, and 1 347 individuals, accounting for 15.80%, 41.39%, and 42.82%, respectively. By the 2020 follow-up, there were 540 cases of CVD, with an overall prevalence of 17.16%. The prevalence of CVD among different METS-VF categories were 12.47%, 14.36%, and 21.60%, respectively. Multivariable logistic regression analysis showed that, after adjusting for demographic factors, lifestyle, and disease history, compared with the persistently low-level group, the persistently high-level group had a higher risk of CVD (OR=1.710, 95%CI: 1.263-2.342). Cumulative METS-VF was positively associated with CVD risk (OR=1.197, 95%CI: 1.113-1.289). Restricted cubic spline analysis indicated a linear relationship between cumulative METS-VF and CVD risk (Pfor nonlinearity >0.05). Conclusion Persistently high levels of METS-VF can increase the risk of CVD among middle-aged and elderly population, and there is a positive dose-response relationship between cumulative METS-VF and CVD risk.
[1] ROTH G A,MENSAH G A,JOHNSON C O,et al.Global burden of cardiovascular diseases and risk factors,1990–2019:update from the GBD 2019 study[J].J Am Coll Cardiol,2020,76(25):2982-3021. [2] 黄文,何亮,傅玲娟,等.动脉粥样硬化性心血管疾病高危人群血脂控制达标的影响因素研究[J].预防医学,2023,35(10):834-839. HUANG W,HE L,FU L J,et al.Factors affecting blood lipid control among residents at a high risk of atherosclerotic cardiovascular disease[J].China Prev Med J,2023,35(10):834-839.(in Chinese) [3] MENSAH G A,FUSTER V,ROTH G A.A heart-healthy and stroke-free world:using data to inform global action[J].J Am Coll Cardiol,2023,82(25):2343-2349. [4] MENSAH G A,FUSTER V,MURRAY C J L,et al.Global burden of cardiovascular diseases and risks,1990-2022[J].J Am Coll Cardiol,2023,82(25):2350-2473. [5] 张小娜. 中老年人肥胖相关人体测量指标变化轨迹的影响因素及其与心血管疾病相关性研究[D].武汉:湖北中医药大学,2024. ZHANG X N.Factors influencing the trajectory of obesity-related anthropometric indicators and their correlation with cardiovascular diseases in middle-aged and elderly people[D].Wuhan:Hubei University of Chinese Medicine,2024.(in Chinese) [6] 杨静芬,黄晓渝.中国人内脏脂肪指数与中老年心血管疾病发病风险的关联性研究[J].临床心血管病杂志,2024,40(1):40-45. YANG J F,HUANG X Y.Association between visceral fat index and the risk of cardiovascular disease in middle-aged and elderly people in China[J].J Clin Cardiol,2024,40(1):40-45.(in Chinese) [7] ASHWELL M,COLE T J,DIXON A K.Obesity:new insight into the anthropometric classification of fat distribution shown by computed tomography[J].Br Med J,1985,290(6483):1692-1694. [8] FENG L,CHEN T,WANG X,et al.Metabolism score for visceral fat(METS-VF):a new predictive surrogate for CKD risk[J].Diabetes Metab Syndr Obes,2022,15:2249-2258. [9] ZHU Y R,ZOU H J,GUO Y M,et al.Associations between metabolic score for visceral fat and the risk of cardiovascular disease and all-cause mortality among populations with different glucose tolerance statuses[J/OL].Diabetes Res Clin Pract,2023[2025-12-02] .https://doi.org/10.1016/j.diabres.2023.110842. [10] BELLO-CHAVOLLA O Y,ANTONIO-VILLA N E,VARGAS-VÁZQUEZ A,et al.Metabolic score for visceral fat(METS-VF),a novel estimator of intra-abdominal fat content and cardio-metabolic health[J].Clin Nutr,2020,39(5):1613-1621. [11] SETIAWAN K E,KURNIAWAN A,CHOWANDA A,et al.Clustering models for hospitals in Jakarta using fuzzy c-means and k-means[J].Procedia Comput Sci,2023,216:356-363. [12] TORUN C,ANKARALıH,CAŞTUR L,et al.Is metabolic score for visceral fat(METS-VF)a better index than other adiposity indices for the prediction of visceral adiposity[J].Diabetes Metab Syndr Obes,2023,16:2605-2615. [13] KAPOOR N,JIWANMALL S A,NANDYAL M B,et al.Metabolic score for visceral fat(METS-VF)estimation-a novel cost-effective obesity indicator for visceral adipose tissue estimation[J].Diabetes Metab Syndr and Obes,2020,13:3261-3267. [14] LIU Q,CUI H Z,SI F,et al.Association of cumulative exposure to metabolic score for visceral fat with the risk of cardiovascular disease and all-cause mortality:a prospective cohort study[J/OL].J Cachexia Sarcopenia Muscle,2025,16(1)[2025-12-02] .https://doi.org/10.1002/jcsm.13702. [15] TRIPATHI H,SINGH A,FARHEEN,et al.The Metabolic Score for Visceral Fat(METS-VF)as a predictor of diabetes mellitus:evidence from the2011-2018 NHANES study[J/OL].PLoS One,2025,20(2)[2025-12-02] .https://doi.org/10.1371/journal.pone.0317913. [16] YANG R J,KUANG M B,QIU J J,et al.Assessing the usefulness of a newly proposed metabolic score for visceral fat in predicting future diabetes:results from the NAGALA cohort study[J/OL].Front Endocrinol(Lausanne),2023,14[2025-12-02] .https://doi.org/10.3389/fendo.2023.1172323.
