Liu Qitong, Sun Ming, Liu Yang, Xu Wenqi, Zheng Huancong, Ning Ning, Huang Rong, Zhou Jin, Shao Jinang, Zhou Wenhui, Chen Shuohua, Wu Shouling, Ma Yanan
Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Department of Biostatistics and Epidemiology, Ministry of Education, School of Public Health, China Medical University, Shenyang, China.
Department of Cardiology, Kailuan General Hospital, Tangshan, China.
Diabetes Metab Res Rev. 2025 Jan;41(1):e70025. doi: 10.1002/dmrr.70025.
Stroke is a common diabetic complication, by which the Chinese visceral adiposity index (CVAI) is confirmed as a better predictor of visceral fat. However, the relationship between CVAI change and the stroke risk among patients with diabetes and prediabetes remains unclear. Therefore, we aimed to examine the association of CVAI trajectory with the risk of stroke.
This prospective cohort study included 11,339 patients with prediabetes and diabetes from the Kailuan study. These participants had complete repeated metabolic and body measurements that formed the continuous CVAI records. The stroke cases were identified by medical records. Latent mixture modelling was conducted to fit four groups of CVAI trajectories. Cox proportional hazard regression models were used to examine the associations between CVAI trajectories and the risk of stroke and its subtypes.
Four distinct CVAI trajectories were identified: the low-stable, moderate low-stable, moderate high-stable, and high-increasing groups. Compared with low-stable CVAI, moderate high-stable (HR: 1.50, 95%CI: 1.10-2.04) and high-increasing CVAI (HR: 2.15, 95%CI: 1.49-3.10) were positively associated with the risk of stroke. Similarly, moderate high-stable (HR: 1.70, 95%CI: 1.21-2.39) and high-increasing CVAI trajectory groups (HR: 2.53, 95%CI: 1.71-3.73) had an increased risk of ischaemic stroke compared with the low-stable CVAI group. However, a significant association was not found between CVAI trajectory and risk of haemorrhage stroke.
A long-term elevated CVAI is associated with a higher risk of stroke, especially ischaemic stroke. This finding suggests the health benefits of low CVAI levels and the importance of regular surveillance among patients with prediabetes and diabetes.
中风是一种常见的糖尿病并发症，中国内脏脂肪指数（CVAI）被证实是内脏脂肪更好的预测指标。然而，糖尿病和糖尿病前期患者中CVAI变化与中风风险之间的关系仍不明确。因此，我们旨在研究CVAI轨迹与中风风险的关联。
这项前瞻性队列研究纳入了开滦研究中的11339例糖尿病前期和糖尿病患者。这些参与者有完整的重复代谢和身体测量数据，形成了连续的CVAI记录。通过病历确定中风病例。采用潜在混合模型拟合四组CVAI轨迹。使用Cox比例风险回归模型研究CVAI轨迹与中风及其亚型风险之间的关联。
确定了四种不同的CVAI轨迹：低稳定、中度低稳定、中度高稳定和高增长组。与低稳定CVAI相比，中度高稳定（HR：1.50，95%CI：1.10 - 2.04）和高增长CVAI（HR：2.15，95%CI：1.49 - 3.10）与中风风险呈正相关。同样，与低稳定CVAI组相比，中度高稳定（HR：1.70，95%CI：1.21 - 2.39）和高增长CVAI轨迹组（HR：2.53，95%CI：1.71 - 3.73）缺血性中风风险增加。然而，未发现CVAI轨迹与出血性中风风险之间存在显著关联。
长期升高的CVAI与较高的中风风险相关，尤其是缺血性中风。这一发现表明低CVAI水平对健康有益，以及对糖尿病前期和糖尿病患者进行定期监测的重要性。
