Association of metabolic score for visceral fat and risk of arterial stiffness and long-term all-cause mortality: a 10-year prospective study.

BACKGROUND: This study aimed to investigate the relationship between the Metabolic Score for Visceral Fat (METS-VF) and all-cause mortality among community-dwelling older adults, and to evaluate the potential mediating effect of brachial-ankle pulse wave velocity (baPWV) in this relationship. METHODS: A prospective cohort of 1,794 community-dwelling elderly Chinese (mean age 71.2) was followed for a median of 9.9 years. METS-VF and baPWV were measured at baseline. We performed Cox regression to determine hazard ratios across METS-VF quartiles, restricted cubic splines (RCS) to examine potential nonlinearity, and mediation analysis to assess the effect mediated through baPWVA. RESULTS: The mean age of the 1,794 participants was 71.2 years. Over a median follow-up of 9.9 years, 328 deaths were recorded. After multivariable adjustment, individuals in the highest METS-VF quartile had a significantly higher risk of mortality compared to those in the lowest quartile (hazard ratio [HR] = 2.43, 95% confidence interval [CI]: 1.46-4.06, p < 0.001). The restricted cubic spline analysis revealed that a nonlinear dose-response relationship was observed between METS-VF and mortality (P for nonlinearity < 0.001). Mediation analysis revealed that baPWV played a significant role in explaining the association between METS-VF and mortality. CONCLUSION: Our study confirms the independent association between METS-VF and all-cause mortality in the community-dwelling elderly. The findings are consistent with a partial mediation effect of arterial stiffness in this relationship, providing insights into a potential underlying mechanism.