ASSOCIATIONS BETWEEN VISCERAL ADIPOSITY INDEX AND CARDIOVASCULAR DISEASES: EVIDENCES FROM THE USA POPULATION-BASED STUDY

Abstract

Therapeutic Area: ASCVD/CVD Risk Assessment Background: Visceral adiposity index (VAI) has been identified as a new cardiometabolic risk marker reflecting abdominal fat distribution and dyslipidemia. Little to minimum study has been done nationally to investigate associations between visceral adiposity index (VAI) and cardiovascular diseases (CVD). We aim to evaluate the relationship between VAI and CVD using a population-based study in the USA. Methods: Data from the National Health and Nutrition Examination Survey (2017-2020) were analyzed in this study. We included participants aged over 20 years. VAI scores were calculated using sex-specific equations which combine high-density lipoprotein (HDL), triglycerides (TG), total cholesterol (TC), body mass index (BMI), and waist circumference (WC). Logistic regression analyses were conducted to measure the relationship between distinct VAI quantiles and increased risk of CVDs. Band-wise medians with linear splines were used to estimate relationships between VAI and multiple CVD manifestations, such as hypertension, angina, coronary heart disease, congestive heart failure, and heart attack. VAI quartiles as independent variables were employed to perform sensitivity analyses with CVD manifestations. Results: A total of 3,746 participants were included. Males comprised of 1,817 (48.5%) participants and females 1,929 (51.5%). The median age (mean ± SD) was 52.00 ± 17.28 years, and the average value (SD) of VAI for males was 220.40 (336.94) and for females was 241.17 (244.58). In the extensively controlled model accounting for covariates, the association between the fourth VAI quartile and cardiovascular diseases was more pronounced compared to the first VAI quartile, with adjusted odds ratio (AOR) and 95% confidence interval (95% CI) values for angina pectoris of 2.48, 1.32-4.67; coronary heart disease, 3.16, 1.81-5.51; congestive heart failure of 1.74, 1.06-2.88; and heart attack, 3.84, 2.11-6.96. There was no significant association with hypertension (p>0.05). Band-wise medians with linear splines revealed statistically significant associations between VAI quartiles and hypertension (p=0.015), angina (p=0.014), coronary heart disease (p=0.014), and heart attack (p<0.01). Sensitivity analyses indicated that the fourth VAI quartile was more strongly associated with an increased risk of angina (OR 2.63, 95% CI 1.41-4.91), coronary heart disease (OR 2.86, 95% CI, 1.67-4.87), congestive heart failure (OR 1.82, 95% CI, 1.11-2.96), and heart attack (OR 3.68, 95% CI 2.06-6.58) than the first VAI quartile. VAI was found to have a superior predictive power for prevalent CVDs than other independent indicators (p<0.05). Conclusions: Visceral adiposity index score is positively associated with angina, coronary heart disease, congestive heart failure, heart attack, but not hypertension. However, there existed statistically significant linear relationship between VAI score and hypertension. Further studies in broader demographics with different comorbidities are needed to investigate the consistency and reliability of these relationships.