Prospective Association Between Chinese Visceral Adiposity Index and Risk of Stroke Incidence in Middle-aged and Elderly Chinese Population

Objective This study aims to analyze the association between the Chinese Visceral Adiposity Index (CVAI) and the risk of stroke onset in middle-aged and older adults (≥45 years) using data from the China Health and Retirement Longitudinal Study (CHARLS). Methods Data from the 2015, 2018, and 2020 CHARLS surveys were used to analyze middle-aged and elderly participants. The outcome was new stroke events (including both hemorrhagic and ischemic strokes) during the follow-up period. General demographic characteristics, lifestyle factors, health status, and blood biomarkers were considered as covariates. The Cox proportional hazards regression model was employed to explore the dose-response relationship between CVAI and the risk of stroke onset. Results A total of 11 432 middle-aged and elderly individuals were included, with an average age of （60.24 ±9.56）years. Among them, 6157 (53.86%) were women and 5275 (46.14%) were men. Over a median follow-up period of 5 years, 905 individuals developed stroke. After adjusting for general demographic characteristics and lifestyle covariates, for each interquartile range (IQR) increase in CVAI, the risk of stroke onset increased by 28% (HR= 1.28, 95% CI: 1.20–1.36). Compared to the first quartile (Q1), the third quartile (Q3) (HR= 1.60, 95% CI: 1.30–1.97) and fourth quartile (Q4) (HR= 2.02, 95% CI: 1.65–2.47) were significantly associated with an increased risk of stroke. Interaction analysis showed a significant interaction between CVAI and gender (P_{for interaction}< 0.001). The restricted cubic spline analysis revealed a non-linear relationship between CVAI and stroke risk (P_nonlinear= 0.005). Conclusions Higher levels of CVAI are associated with an increased risk of stroke. CVAI is an effective biomarker for identifying individuals at high risk for stroke and can be used for primary stroke prevention strategies.