Abstract: Background　Visceral fat is critical for assessing cardiac metabolic risk，but the use of visceral fat area（VFA） to estimate 10-year high risk of having an ischemic cardiovascular diseases（ICVD） is rarely reported.Objective　To identify the cutoff value and sex-specific cutoff VFA for the prediction of 10-year risk of ICVD in populations from Nanjing undergoing physical examination，and to use them to predict the 10-year risk of ICVD in those with normal body mass index（BMI） and increased visceral fat.Methods　We enrolled 3 398 individuals aged 35-59 years who underwent physical examination in Health Management Center，Nanjing Drum Tower Hospital，the Affiliated Hospital of Nanjing University Medical School between June 2016 and June 2017.The simplified prediction models for estimating 10-year risk of ICVD in Chinese adults were used to assess the 10-year risk of ICVD.Human body composition analyzer was adopted to measure the VFA.And the 10-year risk of ICVD in individuals with normal BMI and increased VFA was analyzed.Results　The AUC and cutoff value of VFA were 0.60，85.5 cm2，respectively，for predicting the medium to high 10-year risk of ICVD in the populations undergoing physical examination，0.65，85.5 cm2，respectively，for predicting the medium to high 10-year risk of ICVD for males in the populations，and 0.68，111.9 cm2 for predicting the medium to high 10-year risk of ICVD for females in the populations.230（16.91%） of the 1 360 individuals with normal BMI were found with VFA≥85.5 cm2，including 216 females and 14 males，although females outnumbered males（χ2=150.02，P<0.001）.Compared with males with normal BMI and VFA<85.5 cm2，males with normal BMI and VFA≥85.5 cm2 demonstrated a higher medium to high 10-year risk of ICVD（21.43% vs 5.45%，χ2=3.78，P=0.042），as well as a higher absolute 10-year risk of ICVD〔（6.40±6.77）% vs （3.83±3.38）%；t=2.71，P<0.001〕.Compared with females with normal BMI and VFA<85.5 cm2，females with normal BMI and VFA≥85.5 cm2 showed a higher absolute 10-year risk of ICVD〔（2.04±1.49）% vs （1.65±1.41） %；t=3.46，P=0.010〕.Compared with females with normal BMI and VFA≥85.5 cm2，males with normal BMI and VFA≥85.5 cm2 showed a higher absolute 10-year risk of ICVD（t=7.27，P<0.001）.Conclusion　The cutoff value of VFA estimated by bioelectrical impedance analysis for predicting high 10-year risk of ICVD in populations undergoing physical examination was 85.5 cm2.Increased 10-year risk of ICVD was found in both males and females with normal BMI and increased VFA，and males faced higher risk than females.Therefore，maintaining the normal VFA is of great significance.Moreover，targeted multiple interventions should be delivered in order to reduce the 10-year risk of ICVD.

Key words: Intra-abdominal fat, Body mass index, Cardiovascular diseases, Myocardial ischemia, Risk assessment

摘要： 背景　内脏脂肪对评估心脏代谢风险至关重要，但应用内脏脂肪面积（VFA）估测缺血性心血管病（ICVD）十年发病风险鲜见报道。目的　探讨VFA估测南京地区体检人群ICVD十年发病中高度风险的临界值，明确体质指数（BMI）正常而VFA超标体检者的ICVD十年发病风险。方法　选取2016年6月—2017年6月南京大学医学院附属鼓楼医院健康管理中心35~59岁3 398例体检者为研究对象。均采用国人ICVD十年发病风险简易评估模型进行评估，应用人体成分分析仪测定VFA。分析VFA与BMI正常而VFA超标体检者ICVD十年发病风险的关系。结果　VFA估测体检人群ICVD十年发病中高度风险的受试者工作特征（ROC）曲线下面积（AUC）为0.60，临界值为85.5 cm2；VFA估测男、女体检者ICVD十年发病中高度风险的AUC分别为0.65、0.68，临界值分别为85.5、111.9 cm2。体检者中BMI正常者共1 360例，其中VFA≥85.5 cm2者共230例（占16.91%），女性多于男性（χ2=150.02，P<0.001）。男性中BMI正常VFA≥85.5 cm2者ICVD十年发病中高度风险为21.43%，高于BMI正常VFA<85.5 cm2者（5.45%）（χ2=3.78，P=0.042）。男性中BMI正常VFA≥85.5 cm2者ICVD十年发病风险绝对值高于BMI正常VFA<85.5 cm2者〔（6.40±6.77）%与（3.83±3.38）%；t=2.71，P<0.001〕；女性中BMI正常而VFA≥85.5 cm2者ICVD十年发病风险绝对值高于BMI正常VFA<85.5 cm2者〔（2.04±1.49）%与（1.65±1.41）%；t=3.46，P=0.010〕；男性BMI正常VFA≥85.5 cm2者ICVD十年发病绝对危险高于女性（t=7.27，P<0.001）。结论　采用生物电阻抗分析法检测VFA，并用其估测体检人群ICVD十年发病中高度风险的临界值为85.5 cm2。男、女性BMI正常VFA超标者发生ICVD十年发病风险均增加，且男性高于女性，保持VFA在参考范围非常重要。为降低体检人群ICVD十年发病风险，需综合干预多种危险因素。

关键词: 腹内脂肪, 人体质量指数, 心血管疾病, 心肌缺血, 危险性评估