Cardiovascular disease (CVD) is a major threat to the health of women, particularly postmenopausal women, who are at higher risk. The reduction in estrogen levels following menopause may contribute to visceral fat accumulation, which is closely linked to insulin resistance, chronic inflammation, and lipid metabolism disorders, potentially increasing the risk of CVD. However, the relationship between Chinese visceral adipose index (CVAI) and CVD risk in this population remains insufficiently explored.

To explore the relationship between CVAI and CVD in postmenopausal women, and thereby provide information on the prevention of CVD in this high-risk population.

Based on the data of China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2020, we enrolled 4 743 postmenopausal women aged≥45 years free of CVD at baseline in 2015. The CVAI at baseline was used as the exposure, while incident CVD events during follow-up in 2018 and 2020 served as the outcome. Cox proportional hazards regression models were employed to assess the association between CVAI and CVD risk. Restricted cubic spline (RCS) analysis was further applied to evaluate potential dose-response relationships.

At the end of the follow-up period, the incidence rates of CVD, heart disease, and stroke among the 4 743 postmenopausal women were 20.2% (958/4 743), 13.6% (645/4 743), 8.3% (393/4 743), respectively. The participants were stratified into quartiles based on their baseline CVAI levels, with the following cutoff values: Q1 (≤84.78)(n=742), Q2 (84.78, 108.49)](n=1 249), Q3 (108.49, 132.01](n=1 463), and Q4 (>132.01)(n=1 289). After adjustment for confounding factors, Cox proportional hazards regression showed that compared to the Q1 reference group, women in the CVAI Q2, Q3 and Q4 groups faced significantly elevated risks, the risk of CVD increased by 33% (HR=1.33, 95%CI=1.00-1.76) in Q2, 69% (HR=1.69, 95%CI=1.29-2.21) in Q3 and 82% (HR=1.82, 95%CI=1.38-2.14) in Q4, the risk of stroke increased by 76% (HR=1.76, 95%CI=1.10-2.82) in Q3, 95% (HR=1.95, 95%CI=1.21-3.14) in Q4, and the risk of heart disease increased by 57% (HR=1.57, 95%CI=1.14-2.15) in Q3, and 68% (HR=1.68, 95%CI=1.21-2.33) in Q4, respectively. RCS analysis confirmed dose-response relationships between CVAI and risks of CVD, heart disease, and stroke (P<0.05). Subgroup analyses further indicated that the association between CVAI and CVD risk remained significant only among women aged <65 years, ≥65 years, those with BMI<24.35 kg/m², and rural residents (P<0.05).

Elevated CVAI significantly increases CVD risk in postmenopausal women, particularly in those with lower BMI, or residing in rural areas. Targeted monitoring and management of visceral obesity in these high-risk subgroups are warranted to mitigate CVD incidence.

心血管疾病是威胁女性健康的主要疾病之一，而绝经后女性是心血管疾病的高危人群。绝经后雌激素水平的下降可能促进内脏脂肪的积累，而内脏脂肪的增加与胰岛素抵抗、慢性炎症反应以及脂质代谢紊乱紧密相关，这可能会提高心血管疾病的风险。然而，目前关于内脏脂肪指数（CVAI）与绝经后女性心血管疾病之间联系的研究相对较少。

探索绝经后女性CVAI与心血管疾病之间的关系，为绝经后女性心血管疾病的预防提供借鉴。

基于中国健康与养老追踪调查（CHARLS）2015—2020年数据，纳入2015年基线无心血管疾病且年龄≥45岁绝经后女性4 743人，将参与对象基线CVAI作为暴露因素，将2018年、2020年发生心血管疾病作为结局事件，采用Cox比例风险回归模型分析CVAI与心血管疾病的关系，采用限制性立方样条（RCS）分析评估剂量反应关系。

随访至2020年，4 743名绝经后女性心血管疾病、心脏病、卒中的发病率分别为20.2%（958/4 743）、13.6%（645/4 743）、8.3%（393/4 743）。研究对象基线CVAI的四分位数Q1、Q2、Q3、Q4分别为≤84.78（n=742）、（84.78，108.49]（n=1 249）、（108.49，132.01]（n=1 463）、>132.01（n=1 289）。调整混杂因素后，Cox比例风险回归模型结果显示，以CVAI Q1组为参照，Q2、Q3、Q4组绝经后女性心血管疾病的发生风险分别增加33%（HR=1.33，95%CI=1.00~1.76）、69%（HR=1.69，95%CI=1.29~2.21）、82%（HR=1.82，95%CI=1.38~2.14）；Q3、Q4组绝经后女性卒中的发生风险分别增加76%（HR=1.76，95%CI=1.10~2.82）、95%（HR=1.95，95%CI=1.21~3.14）；Q3、Q4组绝经后女性心脏病的发生风险分别增加57%（HR=1.57，95%CI=1.14~2.15）、68%（HR=1.68，95%CI=1.21~2.33）。RCS分析发现CVAI与心血管疾病、心脏病、卒中发生风险之间均存在剂量-反应关系（P<0.05）。亚组分析结果表明，CVAI与心血管疾病发生风险的关联性在年龄<65岁、≥65岁、BMI<24.35 kg/m²、农村绝经后女性中均显著（P<0.05）。

CVAI升高显著增加绝经后女性心血管疾病的发病风险，尤其在BMI较低及农村女性中，应针对这些亚群加强内脏肥胖的监测与管理，以降低心血管疾病发生风险。