Table_1_Dose–response association between Chinese visceral adiposity index and cardiovascular disease: a national prospective cohort study.docx

BackgroundChinese visceral adiposity index (CVAI) is a reliable visceral obesity index, but the association between CVAI and risk of cardiovascular disease (CVD) remains unclear. We explored the associations of CVAI with incident CVD, heart disease, and stroke and compared the predictive power of CVAI with other obesity indices based on a national cohort study.
MethodsThe present study included 7,439 participants aged ≥45 years from China Health and Retirement Longitudinal Study (CHARLS). Cox regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Restricted cubic splines analyses were adopted to model the dose–response associations. Receiver operator characteristic (ROC) analyses were used to compare the predictive ability of different obesity indices (CVAI, visceral adiposity index [VAI], a body shape index [ABSI], conicity index [CI], waist circumference [WC], and body mass index [BMI]).
ResultsDuring 7 years’ follow‐up, 1,326 incident CVD, 1,032 incident heart disease, and 399 stroke cases were identified. The HRs (95% CI) of CVD, heart disease, and stroke were 1.50 (1.25-1.79), 1.29 (1.05-1.57), and 2.45 (1.74-3.45) for quartile 4 versus quartile 1 in CVAI. Linear associations of CVAI with CVD, heart disease, and stroke were observed (Pnonlinear >0.05) and per-standard deviation (SD) increase was associated with 17% (HR 1.17, 1.10-1.24), 12% (1.12, 1.04-1.20), and 31% (1.31, 1.18-1.46) increased risk, respectively. Per-SD increase in CVAI conferred higher risk in participants aged<60 years than those aged ≥60 years (Pinteraction<0.05). ROC analyses showed that CVAI had higher predictive value than other obesity indices (P<0.05).
ConclusionsCVAI was linearly associated with risk of CVD, heart disease, and stroke and had best performance for predicting incident CVD. Our findings indicate CVAI as a reliable and applicable obesity index to identify higher risk of CVD.

背景 中国内脏脂肪指数（Chinese Visceral Adiposity Index, CVAI）是一种可靠的内脏肥胖评价指标，但CVAI与心血管疾病（Cardiovascular Disease, CVD）发病风险的关联仍不明确。本研究基于一项全国性队列研究，探讨了CVAI与新发心血管疾病、心脏病及卒中的关联，并对比了CVAI与其他肥胖指标的预测效能。

方法 本研究纳入了中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）中7439名年龄≥45岁的参与者。采用Cox回归模型估算风险比（Hazard Ratio, HR）及95%置信区间（Confidence Interval, CI）；使用限制性立方样条分析构建剂量-反应关联模型；通过受试者工作特征（Receiver Operator Characteristic, ROC）分析对比不同肥胖指标的预测能力，包括CVAI、内脏脂肪指数（Visceral Adiposity Index, VAI）、身体形状指数（A Body Shape Index, ABSI）、圆锥指数（Conicity Index, CI）、腰围（Waist Circumference, WC）及体质量指数（Body Mass Index, BMI）。

结果 在7年的随访期间，共确认1326例新发心血管疾病、1032例新发心脏病及399例卒中病例。以CVAI四分位组1为参照，四分位组4的心血管疾病、心脏病及卒中的风险比（95%CI）分别为1.50（1.25~1.79）、1.29（1.05~1.57）及2.45（1.74~3.45）。研究观察到CVAI与心血管疾病、心脏病及卒中呈线性关联（非线性检验P>0.05）；每增加1个标准差（Standard Deviation, SD），对应疾病的发病风险分别升高17%（HR=1.17, 95%CI:1.10~1.24）、12%（HR=1.12, 95%CI:1.04~1.20）及31%（HR=1.31, 95%CI:1.18~1.46）。在年龄<60岁的参与者中，CVAI每增加1个标准差对应的发病风险高于年龄≥60岁的参与者（交互作用P<0.05）。受试者工作特征分析显示，CVAI的预测价值高于其他肥胖指标（P<0.05）。

结论 CVAI与心血管疾病、心脏病及卒中的发病风险呈线性关联，且在预测新发心血管疾病方面表现最优。本研究结果表明，CVAI可作为可靠且实用的肥胖指标，用于识别心血管疾病高风险人群。