Comparative Predictive Value of Three Visceral Adiposity Indices for Cardiovascular Disease: A 17.5‐Year Korean Cohort Study

AIMS: Cardiovascular diseases (CVD) are the leading cause of death worldwide, with excess visceral adipose tissue (VAT) being identified as an independent indicator of poor cardiovascular outcomes. We examined the association between three indices of VAT, namely, metabolic score for visceral fat (METS-VF), visceral adiposity index (VAI), and lipid accumulation product (LAP), and the development of CVD in a large cohort of middle-aged Korean adults. MATERIALS AND METHODS: The study recruited 8192 participants without CVD at baseline from the Korean Genome and Epidemiology Study. METS-VF, VAI, and LAP were calculated using established formulas based on anthropometric and metabolic parameters. Incident CVD was defined based on self-reported physician diagnoses confirmed by trained interviewers. Multivariable Cox proportional hazard regression analyses were performed to estimate the hazard ratio (HR) with a 95% confidence interval (CI) for incident CVD. Heagerty's integrated areas under the receiver operating characteristic curves (iAUC) were used to compare the discriminatory performance of three indices. RESULTS: The adjusted HRs (95% CIs) for incident CVD in the highest tertile compared with the lowest tertile were 1.62 (1.29-2.03), 1.38 (1.08-1.77), and 1.66 (1.32-2.09) for METS-VF, VAI, and LAP, respectively. METS-VF showed statistically higher discriminatory performance than VAI and LAP for incident CVD (p < 0.001), although the overall discriminative ability of indices was modest. CONCLUSIONS: METS-VF, VAI, and LAP were independently associated with an increased risk of CVD events. Among these indices, METS-VF demonstrated relatively better discriminatory performance, suggesting its potential role as a complementary tool for cardiovascular risk stratification.