BMC Cardiovasc Disord. 2026 Jan 17. doi: 10.1186/s12872-026-05511-7. Online ahead of print.
ABSTRACT
BACKGROUND: The Metabolic Score for Visceral Fat (METS-VF) is a novel index reflecting visceral adiposity and metabolic dysfunction, but its association with incident cardiovascular disease (CVD) in adults with Cardiovascular-Kidney-Metabolic (CKM) syndrome stages 0-3 remains unclear. This study aimed to explore this association and quantify the mediating effect of estimated glucose disposal rate (eGDR).
METHODS: Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), we prospectively followed 3,815 adults with CKM syndrome stages 0-3 (baseline 2015) until 2020. The METS-VF profiles comprised baseline METS-VF, cumulative METS-VF, and change patterns identified by latent class growth modeling (LCGM). To investigate associations and underlying mechanisms, Cox proportional-hazards regression, weighted quantile sum (WQS) regression, and mediation analysis were employed. Sensitivity analyses (stratification by CKM syndrome stage and demographics, inverse probability weighting [IPW], Fine-Gray model) were used to support the robustness of the results.
RESULTS: Over a mean 4.4-year follow-up, 18.7% of participants developed CVD. In the fully adjusted model, elevated METS-VF profiles were associated with an increased risk of CVD: baseline METS-VF in the fourth quartile (HR = 1.615, 95% confidence interval (CI): 1.243-2.097), cumulative METS-VF in the fourth quartile (HR = 1.824, 95% CI: 1.397-2.381), and stable high-level METS-VF (Class 3) (HR = 1.288, 95% CI: 1.033-1.610). All associations remained significant following false discovery rate (FDR) correction. Stratified analyses showed stronger associations between METS-VF profiles and incident CVD in late-stage (vs. early-stage) CKM syndrome, with the association more pronounced in males-females only had significant associations in the highest quartile. WQS regression identified Metabolic Score for Insulin Resistance (METS-IR) as the primary contributing factor, with weights of 0.397 in 2011 and 0.375 in 2015. Mediation analysis indicated that eGDR mediated 65.38% of the baseline and 56.72% of the cumulative effects (both P < 0.001). Supplementary mediation analysis using body mass index (BMI)-based METS-VF produced consistent findings.
CONCLUSIONS: METS-VF profiles are independently associated with incident CVD in CKM syndrome stages 0-3, more strongly in late stages. eGDR significantly mediates this relationship, supporting the "obesity-metabolism-vascular" axis. METS-VF may aid CVD risk stratification in CKM syndrome populations, and targeting insulin sensitivity may mitigate CVD risk.
PMID:41547765 | DOI:10.1186/s12872-026-05511-7