A Cohort Study On The Association Between Chinese Visceral Adiposity Index And Cardiovascular Disease Incidence

Objective1.To explore the relationship between Chinese Visceral Adiposity Index（CVAI）and the risk of Cardiovascular Disease（CVD）.2.To evaluate the ability of CVAI to predict the risk of CVD and compare it with other anthropometric indicators related to obesity,so as to provide epidemiological evidence for the prevention and control of CVD in China.MethodsThis study is based on a prospective cohort study called"Northeast China Rural Cardiovascular Health study（NCRCHS）"conducted from 2012 to 2018,using a multi-stage,stratified random cluster sampling scheme,three counties of Dawa,Zhangwu and Liaoyang were selected in the eastern,southern and northern parts of Liaoning Province;one town was randomly selected from each county;6-8 villages（a total of 26 villages）were randomly selected from each town.A total of 11956 people were included at the baseline,and the basic information of the subjects was collected by trained professionals.The baseline population was followed up again in 2018 to collect cardiovascular events.According to the types and characteristics of variables,the appropriate methods were selected for statistical description and statistical analysis of the collected data by using SPSS26.0 software.The Cox proportional hazard model was used to evaluate the association between CVAI and the risk of CVD,expressed by risk ratio（Hazard ratio,HR）and 95%confidence interval（Confidence Intervals,CI）.The restricted cubic spline of Cox model was used to describe the relationship between CVAI and the risk of CVD.At the same time,subgroup analysis was conducted according to age（<60 years old and≥60years old）and sex to explore the relationship between CVAI and the risk of CVD in different ages and genders.In addition,the ability of CVAI to predict the risk of CVD was analyzed by ROC curve and compared with other indexes.The time-dependent ROC curve was drawn to explore the ability of time-dependent CVAI to predict the risk of CVD.Finally,a risk map was drawn to directly compare the correlation between CVAI and other anthropometric indicators and the risk of CVD.Results1.Excluding subjects with baseline or previous cardiovascular disease,loss of follow-up and lack of key indicators,a total of 8723 people were included in this study,including4077 males,accounting for 46.74%.The total incidence of CVD was 5.10%.According to the quartile of CVAI,the incidence of CVD increased with the increase of CVAI level.Correlation analysis showed that there were different degrees of correlation between CVAI and other anthropometric indicators related to obesity.2.Multivariate COX regression analysis showed that CVAI was still an independent risk factor for CVD after correcting potential confounding factors,and the risk of CVD in the highest quartile was 1.61 times higher than that in the first quartile（HR:1.61;95%CI:1.11,2.35）.There was a linear dose-response relationship between CVAI and the risk of CVD(P _nonlinear=0.292).3.The results of stratified analysis showed that after adjusting the possible confounding factors,except for the subgroup≥60 years old,compared with the CVAI first quartile group,the risk of CVD in the fourth quartile group in each subgroup was significantly higher than that in the first quartile group（all P<0.05）,and the risk of CVD in each subgroup increased with the increase of CVAI（all P<0.05）.4.In ROC curve analyses,CVAI was the best predictor of CVD in women but not men.The area under the curve（Area Under Curve,AUC）and 95%CI were 0.679（0.644and 0.714）,and the cutoff value was 88.54.The results of time-dependent ROC curve of CVAI showed that AUC was stable in total population,male and female（all AUC>0.6）.The risk map directly shows that the correlation between CVAI and the risk of CVD is stronger than other anthropometric indicators related to obesity.ConclusionIn the rural population of northeast Liaoning Province,there is a linear dose-response relationship between CVAI and the risk of CVD.CVAI is an independent risk factor for the development of CVD,and the ability of CVAI to predict the onset of CVD in women and people under 60 years old is better than that in men,people aged 60 years and above.Although the results show that the predictive effect of CVAI is better than other obesity-related indicators,but all indicators show low predictive efficiency,all less than 0.700,so the basis that CVAI can be used to predict the risk of CVD is still not sufficient.