Sex‐Stratified Associations of DXA ‐Derived Adiposity, Regional Fat Distribution and Muscle Power With Incident Hospitalised Cardiovascular Disease in Older Adults: A Prospective Cohort Study

ABSTRACT Aims To investigate the sex‐stratified associations of DXA‐derived adiposity, regional fat distribution and muscle power with incident hospitalised cardiovascular disease (CVD) in older Chinese adults. Materials and Methods This prospective cohort included 3168 community‐dwelling older adults (1548 men and 1620 women; median age 72.0 years). DXA assessed body composition and regional fat, and the sit‐to‐stand (STS) test assessed muscle power. Incident hospitalised CVD was ascertained through hospital records. We used sex‐stratified multivariable Cox models as primary analysis, with Fine–Gray models as sensitivity analyses. Results During a median follow‐up of 5.7 years, 330 participants developed CVD (199 men, 131 women). In fully adjusted models, higher adiposity (body fat percentage, fat mass index and waist circumference) was significantly associated with increased CVD risk in men ( HRs per 1‐ SD : 1.24–1.25). Similarly, trunk fat measures, including trunk FMR and trunk FMI , were significantly associated with CVD risk in men, with sex interactions retaining significance after multiple‐comparison correction (both q interaction < 0.05). By contrast, no such associations were observed in women. Higher muscle power was associated with lower CVD risk in women only ( HRs per 1‐ SD : 0.77–0.79). The leg‐to‐total fat ratio was inversely associated with cardiometabolic risk factors in both sexes (all p < 0.05). Results remained robust in sensitivity analyses. Conclusions In this cohort of community‐dwelling older adults, central adiposity was associated with higher CVD risk in men, while greater muscle power was associated with lower risk in women. These exploratory findings highlight the importance of sex‐stratified cardiometabolic risk assessment and warrant future validation.