Association of Cumulative Exposure to Metabolic Score for Visceral Fat With the Risk of Cardiovascular Disease and All‐Cause Mortality: A Prospective Cohort Study
Qian Liu, Haozhe Cui, Fei Si, Yuntao Wu, Jing YuABSTRACT
Background
Previous studies have demonstrated that metabolic score for visceral fat (METS‐VF), a novel surrogate indicator assessing visceral fat, was associated with the risk of hypertension, diabetes mellitus, cardiovascular disease (CVD) and mortality, predicting the risks based on a single METS‐VF measurement can increase limitations of the study. Few studies have investigated the association between cumulative exposure to METS‐VF and risk of CVD and all‐cause mortality. We aimed to examine the association of cumulative METS‐VF with risk for CVD and all‐cause mortality.
Methods
All participants in the study were from the Kailuan Study, which is a large, prospective cohort study, and began in 2006 years. Cumulative METS‐VF was calculated by data from 2006 survey to 2010 survey and defined as the mean METS‐VF for each pair of consecutive surveys multiplied by the time intervals between these two consecutive surveys. The optimal cut‐off value for time‐averaged cumulative METS‐VF associated with CVD was determined using a survival‐time method to calculate maximally selected rank statistics and was used to assess exposure of high METS‐VF. A multivariate Cox proportional hazards regression model was used to assess the risk of CVD and all‐cause mortality during 2010–2022 years (hazard ratio [HR] and 95% confidence interval [95% CI]).
Results
We included 41 756 participants (mean age, [52.72 ± 11.64] years, 78.53% males and 21.47% females). All participants were divided into four groups: Q1 (reference group), Q2, Q3 and Q4 according to the quartiles of cumulative METS‐VF, and exposure duration of high METS‐VF was quantified as 0, 2, 4, and 6 years. During the median follow‐up of 12.01 years, 4008 (9.60%) CVD events and 3944 all‐cause mortality events occurred. After adjusting for potential covariates, compared to participants in Q1 group, the HRs of incident CVD and all‐cause mortality were 1.55 (95% CI, 1.38–1.74) and 1.59 (95% CI, 1.40–1.81) for those in Q2 group, 2.13 (95% CI, 1.91–2.38) and 2.67 (95% CI 2.37–3.01) for those in Q3 group, 2.78 (95% CI, 2.49–3.17) and 4.90 (95% CI 4.36–5.50) for those in Q4 group. The HRs for CVD and all‐cause mortality were increased with exposure duration of high METS‐VF increasing. The result of ROC curve analysis showed that cumulative METS‐VF had the highest predictive for CVD among 4 indexes including cumulative METS‐VF, cumulative waist circumference, cumulative body mass index and cumulative WHtR.
Conclusions
The high cumulative METS‐VF was associated with an increased risk of CVD and mortality, and this association was stronger as exposure to high METS‐VF was prolonged, emphasizing the importance of striving to control the METS‐VF.