CVAI and METS-VF were positively associated with CVD risk and showed slightly better discrimination than other adiposity-related indices, suggesting that visceral adiposity and dyslipidemia remain important correlates of cardiovascular and cerebrovascular risk.
CVAI was significantly associated with CVD risk with an odds ratio of 1.16 per 1 standard deviation increase.
METS-VF was significantly associated with CVD risk with an odds ratio of 1.11 per 1 standard deviation increase.
LAP showed a significant association with increased CVD risk at the third quartile.
TG/HDL-C ratio showed a significant association with increased CVD risk at the third quartile.
CVAI demonstrated the highest AUC values among all tested visceral obesity surrogate markers for predicting heart disease, stroke, and overall CVD.
The study used a retrospective longitudinal design drawing on CHARLS data spanning 2011 to 2018.
This research suggests that certain indirect measures of belly fat and blood fat levels — specifically the Chinese Visceral Adiposity Index (CVAI) and the Metabolic Score for Visceral Fat (METS-VF) — are linked to a higher risk of cardiovascular diseases such as heart disease and stroke. The study analyzed data from thousands of middle-aged and older Chinese adults followed over several years as part of a large national health study. Among five different fat-related measures tested, CVAI was the best at predicting who would develop cardiovascular disease, though its predictive accuracy was modest (AUC values ranging from about 0.58 to 0.61 out of a maximum of 1.0). This research suggests that measuring visceral (internal belly) fat using simple, calculable indices — rather than expensive imaging — may help identify people at higher cardiovascular risk. The lipid accumulation product (LAP) and the triglyceride-to-HDL cholesterol ratio (TG/HDL-C) were also associated with higher CVD risk, particularly at moderate levels of these markers. This points to the role of both fat distribution and blood lipid abnormalities in driving cardiovascular risk. Practically, these findings suggest that visceral adiposity markers like CVAI and METS-VF could be considered alongside traditional risk factors in cardiovascular disease prevention efforts, particularly in older adult populations. However, since the AUC values indicate only modest discriminatory ability, these markers are likely most useful as supplementary screening tools rather than standalone predictors.
Guo P, Liu Y, Chen G, Jiang Y. (2026). The role of visceral obesity surrogate markers in predicting cardiovascular disease: Insights from the CHARLS study.. Medicine. https://doi.org/10.1097/MD.0000000000049097