Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
J Transl Med. 2023 Jul 31;21(1):518. doi: 10.1186/s12967-023-04309-x.
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.
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.
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).
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.
腹部肥胖一直被认为是中风的一个关键危险因素。中国内脏脂肪指数（CVAI）是一种新的腹部肥胖替代指标，已被证实比亚洲人群中的其他指标更好地预测冠心病。然而，关于 CVAI 与中风关系的数据有限。我们的研究目的是评估 CVAI 与中风发生率之间的关系。
本研究纳入了来自中国健康与养老追踪调查（CHARLS）的 7242 名中老年人，并根据 CVAI 的四分位数将他们分为不同的组。感兴趣的结局是中风。使用 Kaplan-Meier 曲线估计中风的累积发生率。采用 Cox 回归分析和多变量调整的受限立方样条（RCS）曲线评估 CVAI 与新发中风之间的关系。进行了多次敏感性分析和亚组分析，以检验结果的稳健性。
在中位 84 个月的随访期间，612 名（8.45%）参与者发生了中风，CVAI 四分位数（Q）1-4 的参与者中风发生率分别为 4.42%、7.29%、9.06%和 13.04%。在完全调整的模型中，CVAI 每增加 1.0-SD，发生中风的风险显著增加：风险比（HR）[95%置信区间（CI）]为 1.17（1.07-1.28）；与 CVAI Q1 的参与者相比，Q2-4 的参与者发生中风的 HR（95%CI）分别为 1.47（1.10-1.95）、1.62（1.22-2.15）和 1.70（1.28-2.27）。亚组分析表明，这种正相关在男性参与者、无糖尿病、高血压和心脏病的患者中具有显著性。所有敏感性分析的结果均稳健。此外，RCS 曲线显示 CVAI 与中风发病风险之间存在显著的剂量-反应关系（非线性趋势 P 值=0.319）。
CVAI 的增加与中风发生率的升高显著相关，尤其是在无高血压、糖尿病和心脏病的男性患者中。这些发现表明，基线 CVAI 是中风风险分层的可靠和有效的生物标志物，对中风的一级预防和公共卫生具有深远意义。
