Longitudinal Associations Between Metabolic Risk Burden and the Cardio–Ankle Vascular Index (CAVI) in Japan Using Health-Check Cohort

Yuzo Horibuchi,1 Larbi Aluariachy,2 Reiko Yamaura,1 Hideko Kasahara,3 Shoichiro Tsugane,1 Tsutomu Yamazaki1 1Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan; 2Research Support Center, International University of Health and Welfare, Tokyo, Japan; 3International University of Health and Welfare Narita Hospital, Narita, Chiba, JapanCorrespondence: Tsutomu Yamazaki, Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan, Tel +81-3-5574-3900, Email [email protected]: The cardio–ankle vascular index (CAVI) is a blood pressure-independent indicator of arterial stiffness. Although CAVI is associated with metabolic risk factors, longitudinal evidence clarifying their relative impact remains limited. This study aimed to examine longitudinal associations between metabolic abnormalities and CAVI in a Japanese health check-up population, focusing on MetS components and waist circumference (WC) status.Patients and Methods: A total of 13,724 adults (7060 men and 6664 women) who underwent annual health check-ups at the International University of Health and Welfare Narita Hospital between 2020 and 2024 were included. Linear mixed-effects models were used to evaluate longitudinal changes in CAVI according to MetS components (blood pressure, glucose, lipids, and WC). Secondary analyses examined CAVI changes by MetS status, WC strata (WC (+)/WC (-)), metabolic risk count (0– 3) and sex.Results: Older age and male sex were independently associated with higher CAVI. Blood pressure and glucose abnormalities showed the strongest associations with elevated CAVI, whereas lipid risk had a modest effect and WC was inversely associated with CAVI. CAVI increased annually overall, but increased more slowly among participants with blood pressure risk. Time interactions for glucose, lipid and WC risk were not significant. MetS was associated with higher baseline CAVI, but longitudinal time interactions did not differ significantly by MetS status. In WC-stratified analyses, baseline CAVI increased stepwise with accumulation of metabolic risk factors in both WC (+) and WC (−) groups, including a substantial WC (-)-subgroup—particularly women—with multiple metabolic risks and elevated CAVI.Conclusion: Longitudinal follow-up revealed modest CAVI progression with attenuated slopes among participants with high-baseline CAVI, indicating that baseline CAVI captures cumulative vascular injury rather than accelerated short-term change. CAVI may complement WC-centered screening by identifying non-obese individuals—especially women—with elevated longitudinal vascular risk.Keywords: arterial stiffness, cardio–ankle vascular index, metabolic syndrome, blood pressure, glucose metabolism, waist circumference