Association between the metabolic score for visceral fat and mortality outcomes in stroke patients

Stroke survivors face an elevated risk of subsequent mortality. While visceral adiposity is linked to adverse cardiometabolic outcomes, traditional anthropometric indices fail to adequately capture its metabolic burden. The metabolic score for visceral fat (METS-VF) is a novel indicator of visceral fat-related metabolic activity; however, its prognostic value in stroke patients remains unclear. This national cohort study included 1557 adults with a history of stroke from the National Health and Nutrition Examination Survey 1999 to 2018. METS-VF was calculated and stratified into tertiles. All-cause and cardiovascular mortality data were obtained via linkage to the National Death Index. Associations between METS-VF and mortality outcomes were evaluated using Kaplan–Meier survival analysis, multivariable Cox proportional hazards models, and restricted cubic splines (RCS). During a median follow-up of 80 months, 665 all-cause deaths and 262 cardiovascular deaths occurred. In fully adjusted models, METS-VF served as an independent predictor for both all-cause (hazard ratio [HR], 1.62; 95% CI, 1.05–2.50) and cardiovascular mortality (HR, 1.81; 95% CI, 1.09–3.67). Participants in the highest METS-VF tertile exhibited the greatest mortality risk. Furthermore, RCS analyses confirmed significant linear dose-response relationships with no evidence of nonlinearity. These associations remained robust across various demographic and clinical subgroups. Higher METS-VF is independently and linearly associated with increased subsequent all-cause and cardiovascular mortality among individuals with a history of stroke. As a highly accessible metabolic indicator, METS-VF can enhance risk stratification and guide targeted secondary prevention strategies in this high-risk population.