Association of metabolism score for visceral fat with new-onset cardiovascular disease in patients with metabolic syndrome: two large prospective cohorts in Europe and Asia

Objective: Metabolic syndrome (MetS) significantly increases the risk of cardiovascular disease (CVD). The metabolism score for visceral fat (METS-VF) is a novel assessment tool with potential to replace visceral adipose tissue measurement. This study aimed to investigate the association between METS-VF and new-onset CVD in participants with MetS. Methods: This study utilized data from two prospective cohorts: UK Biobank (UKB) and the China Health and Retirement Longitudinal Study (CHARLS). METS-VF was calculated based on relevant metabolic parameters. Multivariate Cox regression analysis and restricted cubic spline (RCS) analyses were conducted to assess the relationship between METS-VF and new-onset CVD. The interaction between METS-VF and CVD polygenic risk score (PRS) was examined in UKB to explore the contribution of genetic factors. Receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the diagnostic capability of METS-VF for new-onset CVD. Subgroup analyses were performed to confirm the robustness of the results. Results: A total of 101,292 individuals from the UK Biobank and 1,680 individuals from CHARLS were included. The median follow-up periods were 14.6 years in UKB and 5.0 years in CHARLS. High METS-VF was significantly associated with an increased risk of new-onset CVD in both UKB (HR = 1.63, 95% CI: 1.56-1.71) and CHARLS (HR = 2.114, 95% CI: 1.52-2.94) compared with low METS-VF. Individuals with the highest METS-VF and high genetic risk exhibited the highest risk of new-onset CVD (HR = 2.36, 95% CI: 2.14-2.61). The diagnostic capability of METS-VF for new-onset CVD was superior to other obesity-related indicators and demonstrated consistently stable performance. Conclusions: METS-VF is a valuable indicator for predicting new-onset CVD in individuals with MetS, providing new insights into the prevention and management of CVD in high-risk populations.