Association between Chinese visceral adiposity index and risk of stroke incidence in middle-aged and elderly Chinese population: evidence from a large national cohort study

Abstract

Background Abdominal obesity has long been considered as a crucial risk factor of stroke. Chinese visceral adiposity index (CVAI), a novel surrogate indicator of abdominal obesity, has been confirmed as a better predictor for coronary heart disease than other indicators in Asian population. However, the data on the relationship of CVAI with stroke is limited. The objective of our study is evaluating the relationship between CVAI and stroke incidence. Methods In the present study, we enrolled 7242 middle-aged and elderly residents from the China Health and Retirement Longitudinal Study (CHARLS) and placed them into groups according to quartile of CVAI. The outcome of interest was stroke. Kaplan–Meier curves were used to estimate the cumulative incidences of stroke. Cox regression analyses and multivariable-adjusted restricted cubic spline (RCS) curves were performed to evaluate the relationship between CVAI and incident stroke. Multiple sensitivity analyses and subgroups analyses were performed to test the robustness of the findings. Results During a median 84 months of follow-up, 612 (8.45%) participants experienced incident stroke, and the incidences of stroke for participants in quartiles (Q) 1–4 of CVAI were 4.42%, 7.29%, 9.06% and 13.04%, respectively. In the fully adjusted model, per 1.0-SD increment in CVAI has a significant increased risk of incident stroke: hazard ratio (HR) [95% confidence interval (CI)] was 1.17 (1.07–1.28); compared with participants in Q1 of CVAI, the HRs (95% CI) of incident stroke among those in Q2–4 were 1.47 (1.10–1.95), 1.62 (1.22–2.15), and 1.70 (1.28–2.27), respectively. Subgroups analyses suggested the positive association was significant in male participants, without diabetes, hypertension and heart disease. The findings were robust in all the sensitivity analyses. Additional, RCS curves showed a significant dose-response relationship of CVAI with risk of incident stroke (P for non-linear trend = 0.319). Conclusion Increased CVAI is significantly associated with higher risk of stroke incidence, especially in male individuals, without hypertension, diabetes and heart disease. The findings suggest that baseline CVAI is a reliable and effective biomarker for risk stratification of stroke, which has far-reaching significance for primary prevention of stroke and public health.

The association between Chinese visceral adiposity index and cardiometabolic multimorbidity among Chinese middle-aged and older adults: a national cohort study

“…The association between CVAI and cardiometabolic diseases has been confirmed in several previous studies. For example, a recent study based on the CHARLS found that an increase in the CVAI predicted the risk of developing future strokes among middle-aged and older adults ( 23 ). A U-shaped relationship was also found between CVAI and type 2 diabetes mellitus ( 27 ).…”

Association of adiposity indicators with cardiometabolic multimorbidity risk in hypertensive patients: a large cross-sectional study

“…CVAI is considered to be a reliable indicator of visceral adipose scores specific to the Chinese population, and it has been used to assess various diseases, including diabetes, stroke, and cardiovascular events ( 22 , 44 , 45 ). Studies have shown that CVAI is associated with an increased risk of diabetes in both Chinese and Japanese adult populations ( 22 , 46 ).…”

“…Studies have shown that CVAI is associated with an increased risk of diabetes in both Chinese and Japanese adult populations ( 22 , 46 ). The China Health and Retirement Longitudinal Study, including 7242 middle-aged and elderly residents, showed that CVAI was associated with a 17% increased risk of incident stroke ( 44 ). Two cohort studies conducted in Xinjiang and Tangshan showed that CVAI was associated with an elevated risk of cardiovascular events in patients with hypertension and type 2 diabetes ( 45 , 47 ).…”

“…Similarly, a cohort study found no nonlinear relationship between CVAI and the risk of diabetes mellitus in non-obese Japanese adults ( 52 ). Additionally, the China Health and Retirement Longitudinal Study found no evidence of a nonlinear link between CVAI and the incidence of stroke ( 44 ). Overall, the findings from various dose-response analyses across different studies have consistently indicated that higher levels of CMI, LAP, and VAI are linked to an increased diseases burden and mortality, including hypertension.…”

Associations between Chinese visceral adiposity index and risks of all‐cause and cause‐specific mortality: A population‐based cohort study

“…Moreover, the Chinese VAI (CVAI), which was modified according to differences in body adipose tissue distribution between Asian and White people, 5 was reported to be more effective than BMI and WC in predicting metabolic syndrome, hypertension (HTN), diabetes mellitus (DM), 6 prediabetes, 5,7 and CVD 8 . Previous epidemiological studies found positive associations of CVAI with HTN, 9,10 DM, 7,11 HTN‐DM comorbidity, 12 stroke 13 and CVD 14,15 . Nevertheless, several crucial questions have yet to be answered, including the associations between CVAI and all‐cause and cause‐specific mortality, and whether heterogeneity exists in the associations across subgroups.…”