METS-VF and METS-IR as predictors of acute myocardial infarction in U.S. adults: Evidence from NHANES 2005 to 2018

Visceral adiposity and insulin resistance are key contributors to acute myocardial infarction (AMI), yet their combined predictive value remains unclear. Metabolic score for visceral fat (METS-VF) and metabolic score for insulin resistance (METS-IR) are novel indices reflecting visceral fat and insulin resistance, respectively, with potential to improve AMI risk assessment and guide early preventive strategies in clinical practice. A cross-sectional analysis was conducted using data from 29,505 adults aged ≥ 20 years in the National Health and Nutrition Examination Survey (NHANES) 2005 to 2018. METS-VF and METS-IR were calculated from clinical and biochemical parameters. Associations with self-reported AMI were assessed using multivariable logistic regression and restricted cubic spline models, adjusting for demographic, socioeconomic, lifestyle, and clinical covariates. Subgroup analyses were performed by sex and obesity status. Participants with METS-VF > 6.94 and METS-IR > 35.5 had significantly higher AMI risk (adjusted odds ratios (ORs) = 1.51 [95% CI: 1.10-2.07] and 1.01 [95% CI: 1.00-1.02], respectively). Nonlinear dose-response relationships were observed, with risk rising steeply above these thresholds. Stratified analyses showed the associations were significant in males (METS-VF OR = 2.12, 95% CI: 1.40-3.23; METS-IR OR = 1.02, 95% CI: 1.01-1.04) and non-obese individuals (METS-VF OR = 1.68, 95% CI: 1.18-2.40; METS-IR OR = 1.01, 95% CI: 1.00-1.02), but not in females or obese subgroups. METS-VF and METS-IR are independent, nonlinear predictors of AMI risk, with stronger predictive value in males and non-obese adults. By integrating measures of visceral fat and insulin resistance, these indices may help clinicians identify high-risk individuals and tailor preventive interventions, thereby enhancing personalized cardiovascular risk assessment and improving early management outcomes.