Association between changes in Chinese visceral adiposity index and cardiovascular disease among middle-aged and older Chinese adults

Previous studies have established visceral adiposity as a risk factor for cardiovascular disease (CVD), but the relationship between longitudinal changes in Chinese Visceral Adiposity Index (CVAI) and CVD risk has not been thoroughly investigated. This study aimed to investigate the longitudinal association between CVAI changes and CVD risk in Chinese middle-aged and older adults. A total of 3,805 CVD-free participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study (CHARLS) were followed from 2015 until 2020 (median follow-up: 4.9 years) to detect incident CVD. Participants were categorized based on CVAI changes using K-means clustering. During follow-up, 375 participants (9.86%) developed CVD. Multivariable-adjusted Cox proportional hazards regression and restricted cubic spline regression models were used for data analysis. Compared with the low-increasing CVAI group, the hazard ratios (HR) were 1.25 (95% confidence interval [CI], 0.89 to 1.74) for moderate-increasing, 1.56 (95% CI, 1.09 to 2.24) for moderate high-increasing, and 1.87 (95% CI, 1.21 to 2.89) for high-increasing CVAI groups (P for trend = 0.002). Each standard deviation increase in cumulative CVAI was associated with a 20% increased CVD risk (HR 1.20, 95% CI, 1.06 to 1.37). The relationship was linear (P for nonlinearity = 0.998). Cumulative CVAI showed modest predictive performance (area under the curve 0.598), slightly better than body mass index, waist circumference, and Visceral Adiposity Index. These findings suggest CVAI changes may provide additional information for comprehensive CVD risk assessment, though further validation is needed given the modest predictive accuracy.