Association between cumulative exposure to metabolic score for visceral fat and the risk of stroke in a population with cardiovascular-kidney-metabolic syndrome stages 0-3: a nationwide prospective cohort study.

BACKGROUND AND AIM: The association between cumulative exposure to METS-VF and the risk of stroke at cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 remains inadequately understood. This study aimed to investigate the association between cumulative METS-VF and incident stroke in this population.

METHODS AND RESULTS: This analysis was based on data from the China Health and Retirement Longitudinal Study (CHARLS), focusing on participants assigned to CKM syndrome stages 0-3. An optimal cut-off for time-averaged cumulative METS-VF in relation to stroke was identified through the survival-time method incorporating maximally selected rank statistics. We applied Cox proportional hazards regression models to examine the association between cumulative METS-VF and stroke risk. Over a five-year follow-up period, 235 of the 3227 participants experienced stroke. In participants with CKM syndrome stages 0-3, cumulative METS-VF showed a positive association with stroke risk. After adjustment for confounding variables in model 3, participants classified into Q2, Q3, and Q4 showed a significantly higher risk of stroke than those in Q1. These were 1.664 (1.070-2.588), 1.765 (1.145-2.719), and 2.261 (1.478-3.459) for the corresponding hazard ratios (HRs) and 95% confidence intervals (CIs). A cumulative average METS-VF level greater than 6.53 was associated with a significantly elevated risk of stroke relative to participants with values below 6.53 (HR = 1.781, 95% CI: 1.296-2.448).

CONCLUSIONS: Cumulative METS-VF is significantly associated with an increased risk of stroke. Among individuals with CKM stages 0-3, time-averaged assessment of longer-term METS-VF burden may help identify individuals at elevated risk of stroke, thereby providing supportive evidence for early preventive strategies.