Association between visceral adiposity index and cardiovascular disease: A systematic review and meta-analysis

The visceral adiposity index (VAI) is a novel marker for evaluating visceral fat accumulation. Some studies have confirmed the association between visceral fat accumulation and cardiovascular disease (CVD) risk. This meta-analysis aimed to explore the association between VAI and multiple cardiovascular outcomes.

PubMed, Embase, and Web of Science databases were searched for studies published before June 13th, 2025, that reported associations between VAI and CVD, stroke, cardiovascular death, or coronary heart disease (CHD). Effect sizes were pooled using random-effects models, and dose-response analyses were performed. Seventeen observational cohort studies involving 824,268 participants were included. Compared with the lowest VAI category, high VAI was associated with increased risks of CVD (relative risk [RR] = 1.55, 95 % confidence interval [CI] 1.36-1.76; I² = 0.0 %, P < 0.001), stroke (RR = 1.45, 1.27-1.65; I² = 45.9 %, P < 0.001), cardiovascular death events (RR = 1.38, 1.27-1.49; I² = 55.3 %, P < 0.001), and CHD (RR = 1.23, 1.16-1.31; I² = 26.9 %, P < 0.001). Dose-response analysis showed that each 0.5-unit increase in VAI was associated with a 14.4 % increase in CVD risk and a 19.0 % increase in the risk of cardiovascular death events. However, the association between VAI and stroke risk was nonlinear (χ² = 4.86, P = 0.028).

High VAI is associated with an increased risk of CVD, stroke, cardiovascular death, and CHD. Moreover, VAI showed a linearly increasing association with CVD and cardiovascular death events, while a nonlinear association was observed with stroke. VAI may serve as a risk marker for adverse cardiovascular outcomes, warranting clinical consideration. The study was registered in PROSPERO (CRD420251003543).