Visceral adiposity measures are strongly associated with cardiovascular disease among female participants in Southwest China: A population-based prospective study

Abstract

Background and aims: Controversy remains regarding the prediction effects of different adiposity measure indicators for the risk of cardiovascular disease (CVD). Our study aimed to assess the associations of three traditional anthropometric indicators, namely, waist circumference (WC), waist-to-height ratio (WHtR), and body mass index (BMI) as well as three non-traditional anthropometric indicators, namely, the Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), and body shape index (ABSI), with the risk of CVD among Southwest Chinese population.

Methods: Our study was based on the Guizhou Population Health Cohort Study (GPHCS) conducted from 2010 to 2020. A total of 9,280 participants were recruited from 12 areas in Guizhou Province, China, from November 2010 to December 2012, and followed up for major chronic diseases until December 2020. A total of 7,837 individuals with valid data were included in this analysis. The gender-specific associations of WC, WHtR, BMI, CVAI, LAP, and ABSI with CVD were evaluated using Cox proportional hazards models. Receiver operating characteristic (ROC) curve analysis was used to estimate the prediction powers of different indicators for CVD.

Results: No association of six indicators with CVD was observed among male participants. Female participants with either WC-based central obesity (HR: 1.82, 95% CI: 1.12-2.97) or WHtR-based central obesity (HR: 1.68, 95% CI: 1.07-2.64) had a higher risk of CVD, after adjusted for age, area, ethnic group, smoking, alcohol drinking, MET, previous history of diabetes, hypertension and dyslipidemia, medication use, and nutraceutical intake. Compared with female participants in the lowest quartile (Q1), those in the highest quartile (Q4) of WHtR (HR: 2.24, 95% CI: 1.17-4.27), CVAI (HR: 3.98, 95% CI: 1.87-8.49), and ABSI (HR: 1.94, 95% CI: 1.06-3.52) had an increased risk for incident CVD. CAVI showed the maximum predictive power of CVD with the biggest AUC of 0.687 (95% CI: 0.654-0.720) compared to other indicators in female participants.

Conclusions: Visceral adiposity measures, especially CVAI, are stronger predictive indicators of CVD among female and not male participants in Southwest China. Different anthropometric indexes need to be combined to comprehensively assess health risks.

Keywords: anthropometric; cardiovascular disease; cohort study; southwest China; visceral adiposity.

Figure 1

Flowchart of the study.

Figure 2

Receiver operating characteristic (ROC) curve and area under ROC curve (AUC) of traditional and non-traditional anthropometric indicators for predicting CVD among male and female participants based on the adjusted Cox regression model (Model 3). (A, B) For waist circumference (WC), waist-to-height ratio (WHtR), and body mass index (BMI), respectively. (C, D) For Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), and body shape index (ABSI).

Figure 3

Adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for overall CVD or overall CVD associated with traditional and non-traditional anthropometric indicators among female participants after stratified by age, area, and ethnic group based on adjusted Cox regression model (Model 3). (A) For waist circumference (WC); (B) for waist-to-height ratio (WHtR); (C) for body mass index (BMI); (D) for Chinese visceral adiposity index (CVAI); (E) for lipid accumulation product (LAP); (F) for body shape index (ABSI); *p < 0.05; **0.05 < p <0.01;***0.01 < p < 0.001.