Correlations between the cumulative metabolic score for visceral fat and its dynamic trajectories with the onset of cardiovascular disease in middle-aged and older adults: findings from two prospective cohorts

BACKGROUND: Cardiovascular disease (CVD) remains a leading cause of global mortality. The metabolic score for visceral fat (Mets-VF) integrates metabolic dysfunction and visceral adiposity, yet the effects of its long-term cumulative exposure (cuMets-VF) and dynamic trajectories on CVD risk remain underexplored. METHODS: = 1,071). Mets-VF trajectories were identified using K-means clustering. Incident CVD was ascertained during follow-up. Cox proportional hazards models were applied to evaluate associations. RESULTS: Over a median follow-up of approximately 5.0 years in CHARLS and 9.0 years in the ELSA, higher cuMets-VF levels and adverse trajectories were significantly associated with an increased CVD risk. Each unit increase in cuMets-VF was associated with a 14% higher risk of CVD in CHARLS (HR = 1.14, 95% CI: 1.07-1.22) and a 13% higher risk in ELSA (HR = 1.13, 95% CI: 1.01-1.26). Participants in the high-risk stable trajectory showed the highest cumulative CVD incidence (21.7% in CHARLS and 21.5% in ELSA). CONCLUSION: Long-term cumulative exposure to elevated Mets-VF and persistently adverse trajectories are robust predictors of incident CVD in middle-aged and older adults.