Association of the skeletal muscle mass-to-visceral fat area ratio with cardiovascular disease: a cross-sectional study based on NHANES

PURPOSE: To examine the association between the skeletal muscle mass-to-visceral fat area ratio (SVR) and prevalent cardiovascular disease (CVD) in a nationally representative U.S. METHODS: We analyzed data from the U.S. National Health and Nutrition Examination Survey (NHANES), 2011-2018. Associations of SVR with composite CVD and its subtypes (heart failure [HF], coronary heart disease [CHD], angina pectoris [AP], myocardial infarction [MI], or stroke) were estimated using multivariable logistic models; linear trend across SVR tertiles was tested, and nonlinearity was assessed using restricted cubic spline (RCS) models. Subgroup analyses assessed heterogeneity. RESULTS: The sample comprised 9,997 participants. In multivariable-adjusted logistic models, higher SVR was associated with lower odds of CVD (Model 4: OR = 0.44; 95% CI 0.29-0.67; P < 0.001), with a dose-response (P for trend = 0.001). In subtype analyses, the highest SVR category was associated with lower odds of HF (OR = 0.42, 95% CI 0.18-0.96; P = 0.047), CHD (OR = 0.28, 95% CI 0.11-0.71; P = 0.011), and MI (OR = 0.33, 95% CI 0.11-0.94; P = 0.045), with significant trends for all three outcomes (P for trend < 0.05). RCS models showed nonlinear associations of SVR with composite CVD, CHD, and MI, but not with HF, stroke or AP. Subgroup analyses detected interactions for poverty-income ratio (PIR) and BMI strata (both P for interaction = 0.005). CONCLUSION: Higher SVR may be a potential CVD risk marker, whereas associations with AP and stroke were weak or non-significant. Prospective validation is warranted. LEVEL OF EVIDENCE: Level V-cross-sectional observational study.