Risk stratification in early-stage Cardiovascular-Kidney-Metabolic Syndrome: The Potency of visceral adiposity and...

Cardiovascular-kidney-metabolic (CKM) syndrome defines a pathophysiological continuum linking obesity, metabolic dysfunction, chronic kidney disease, and cardiovascular disease. Stages 0-3 represent a critical subclinical window for reversible intervention, yet conventional risk stratification remains rudimentary. Body mass index (BMI) fails to capture visceral adiposity and metabolic heterogeneity. Recently, surrogate indices integrating anthropometric and metabolic data, such as waist-to-height ratio (WHtR), visceral adiposity index (VAI), and the metabolic score for visceral fat (METS-VF), have emerged as scalable tools for identifying disproportionate visceral-metabolic burden. This review synthesizes the longitudinal evidence and biological rationale, highlighting mechanisms such as mitochondrial stress and lipid peroxidation, for these markers in early-stage CKM. We demonstrate that indices reflecting visceral lipotoxicity and insulin resistance offer superior prognostic resolution compared to traditional measures during the preclinical phase. Furthermore, we propose a stage-oriented framework to integrate these low-cost markers into clinical management, while delineating unresolved issues regarding ethnicity-specific thresholds and nonlinear risk patterns.