Association of Visceral Adiposity, Core Skeletal Muscle Mass, Atherogenic Index of Plasma, and Renal Function (CKD-EPI) with Framingham Cardiovascular Risk Score in Adults: A Cross-Sectional Study
DOI:
https://doi.org/10.30701/ijc.2103Keywords:
Visceral adiposity, Atherogenic index of plasma, Core skeletal muscle mass, Renal function, Framingham risk scoreAbstract
Background: Cardiovascular risk prediction increasingly incorporates markers of adiposity, muscle composition, and metabolic function. This study examined the associations among visceral adiposity, Core Skeletal Muscle Mass (CSMM), Atherogenic Index of Plasma (AIP), and renal function assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in relation to the Framingham Cardiovascular Risk Score (FRS) in adults, aiming to elucidate their interrelated contributions to Cardiovascular Disease (CVD) prevention.
Methods: A cross-sectional study was conducted among 520 adults aged 30–75 years. Visceral adiposity, CSMM, AIP, and CKD-EPI were measured and analyzed alongside FRS. Path analysis using SmartPLS assessed direct and indirect associations. The sample size and analytical framework followed current epidemiological standards for body composition indices and risk prediction models.
Results: Visceral adiposity demonstrated a strong positive association with AIP (? = 0.339), which in turn correlated with both CKD-EPI (? = 0.030) and the FRS (? = 0.389). CSMM was inversely related to AIP (? = ?0.070), suggesting a protective effect, while CKD-EPI showed a modest negative association with the FRS (? = ?0.080). The overall model indicated that visceral adiposity and AIP are key mediators in cardiovascular risk estimation among adults.
Conclusions: Visceral adiposity and AIP are significantly linked to cardiovascular risk as quantified by the FRS, with renal function and skeletal muscle mass serving as secondary modulators. These findings highlight the importance of integrating adiposity and metabolic markers into CVD risk stratification, supporting tailored preventive strategies in clinical practice.
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References
1. WHO CVD Risk Chart Working Group. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health. 2019;7(10):e1332-45. doi:10.1016/S2214-109X(19)30318-3.
2. Mendoza W, Miranda JJ. Global shifts in cardiovascular disease, the epidemiologic transition, and other contributing factors: toward a new practice of global health cardiology. Cardiol Clin. 2017;35(1):1-12. doi:10.1016/j.ccl.2016.08.004.
3. Patel D, Koschinsky ML, Agarwala A, Natarajan P, Bhatia HS, Mehta A, et al. Role of lipoprotein(a) in atherosclerotic cardiovascular disease in South Asian individuals. J Am Heart Assoc. 2025;14(14). doi:10.1161/JAHA.124.040361.
4. Rehman S, Rehman E, Ikram M, Jianglin Z. Cardiovascular disease (CVD): assessment, prediction and policy implications. BMC Public Health. 2021;21(1):1299. doi:10.1186/s12889-021-11334-2.
5. Pamungkasari EP, Balgis B, Koot J, Landsman J, Pardoel Z, Rusnak M, et al. Identifying relevant diabetes and hypertension control management guidelines in primary healthcare and community settings in Indonesia: a Delphi survey. PLoS One. 2024;19(11):e0310295. doi:10.1371/journal.pone.0310295.
6. Xu Y, Hu T, Shen Y, Wang Y, Bao Y, Ma X. Contribution of low skeletal muscle mass in predicting cardiovascular events: a prospective cohort study. Eur J Intern Med. 2023;114:113-9. doi:10.1016/j.ejim.2023.05.007.
7. Tyrovolas S, Panagiotakos D, Georgousopoulou E, Chrysohoou C, Tousoulis D, Haro JM, et al. Skeletal muscle mass in relation to 10 year cardiovascular disease incidence among middle aged and older adults: the ATTICA study. J Epidemiol Community Health. 2020;74(1):26-31. doi:10.1136/jech-2019-212268.
8. Rabiee Rad M, Ghasempour Dabaghi G, Darouei B, et al. The association of atherogenic index of plasma with cardiovascular outcomes in patients with coronary artery disease: a systematic review and meta-analysis. Cardiovasc Diabetol. 2024;23:119. doi:10.1186/s12933-024-02198-y.
9. Zhi YW, Chen RG, Zhao JW, Zhou SX, He ZJ. Association between atherogenic index of plasma and risk of incident major adverse cardiovascular events. Int Heart J. 2024;65(1):39-46. doi:10.1536/ihj.23-406.
10. Xin G, Li Q, Sheng C, et al. Comparation of two cystatin C-based eGFR equations in assessing risk of all-cause mortality and incident cardiovascular disease. Nutr Metab (Lond). 2024;21:94. doi:10.1186/s12986-024-00870-4.
11. Walther CP, Gregg LP, Navaneethan SD. Cardiovascular disease risk estimates in the US CKD population using the PREVENT equation. Am J Kidney Dis. 2025;86(1):10-17. doi:10.1053/j.ajkd.2025.01.012.
12. de Menezes-Júnior LAA, de Moura SS, Carraro JCC, et al. Framingham score adapted: a valid alternative for estimating cardiovascular risk in epidemiological studies. BMC Cardiovasc Disord. 2025;25:187. doi:10.1186/s12872-025-04579-x.
13. Ballin M, Nordström P, Niklasson J, Nordström A. Associations of visceral adipose tissue and skeletal muscle density with incident stroke, myocardial infarction, and all-cause mortality in community-dwelling 70-year-old individuals: a prospective cohort study. J Am Heart Assoc. 2021;10(9). doi:10.1161/JAHA.120.020065.
14. Cesaro A, De Michele G, Fimiani F, Acerbo V, Scherillo G, Signore G, et al. Visceral adipose tissue and residual cardiovascular risk: a pathological link and new therapeutic options. Front Cardiovasc Med. 2023;10:1187735. doi:10.3389/fcvm.2023.1187735.
15. Zhang J, Li M, Wang T, Tian W, Ju J, Xu H. Association between visceral adiposity index and all-cause and cardiovascular mortality in the non-elderly adults. Front Endocrinol (Lausanne). 2025;16:1523731. doi:10.3389/fendo.2025.1523731.
16. Kim SH, Kang HW, Jeong JB, Lee DS, Ahn D, Kim JW, et al. Association of obesity, visceral adiposity, and sarcopenia with an increased risk of metabolic syndrome: a retrospective study. PLoS One. 2021;16(8):e0256083. doi:10.1371/journal.pone.0256083.
17. Aminuddin A, Noor Hashim MF, Mohd Zaberi NA, Zheng Wei L, Ching Chu B, Jamaludin NA, et al. The association between arterial stiffness and muscle indices among healthy subjects and subjects with cardiovascular risk factors: an evidence-based review. Front Physiol. 2021;12:742338. doi:10.3389/fphys.2021.742338.
18. Souza ACDAH, Rosenthal MH, Moura FA, Divakaran S, Osborne MT, Hainer J, et al. Body composition, coronary microvascular dysfunction, and future risk of cardiovascular events including heart failure. JACC Cardiovasc Imaging. 2024;17(2):179-91. doi:10.1016/j.jcmg.2023.07.014.
19. Luo Y, Zhan X, Liu Y, Chen L, Zhu L, Cai W. Predicted visceral adiposity index in relation to risk of coronary heart disease and all-cause mortality: insights from NHANES. Front Endocrinol (Lausanne). 2023;14:1296398. doi:10.3389/fendo.2023.1296398.
20. Gómez-Ambrosi J. Adipose tissue inflammation. Cells. 2023;12(11):1484. doi:10.3390/cells12111484.
21. Vekic J, Zeljkovic A, Cicero AFG, Janez A, Stoian AP, Sonmez A, et al. Atherosclerosis development and progression: the role of atherogenic small, dense LDL. Medicina (Kaunas). 2022;58(2):299. doi:10.3390/medicina58020299.
22. Li Y, Feng Y, Li S, Ma Y, Lin J, Wan J, et al. The atherogenic index of plasma (AIP) is a predictor for the severity of coronary artery disease. Front Cardiovasc Med. 2023;10:1140215. doi:10.3389/fcvm.2023.1140215.
23. Lioy B, Webb RJ, Amirabdollahian F. The association between the atherogenic index of plasma and cardiometabolic risk factors: a review. Healthcare (Basel). 2023;11(7):966. doi:10.3390/healthcare11070966.
24. Noels H, Van der Vorst EP, Rubin S, Emmett A, Marx N, Tomaszewski M, et al. Renal-cardiac crosstalk in the pathogenesis and progression of heart failure. Circ Res. 2025;136(11):1306-34. doi:10.1161/CIRCRESAHA.124.325488.
25. Talha I, Elkhoudri N, Hilali A. Major limitations of cardiovascular risk scores. Cardiovasc Ther. 2024;2024(1):4133365. doi:10.1155/2024/4133365.
26. Banks E, Welsh J, Joshy G, Martin M, Paige E, Korda RJ. Comparison of cardiovascular disease risk factors, assessment and management in men and women, including consideration of absolute risk: a nationally representative cross-sectional study. BMJ Open. 2020;10(12):e038761. doi:10.1136/bmjopen-2020-038761.
27. Shin JH, Cheong JI, Cheuh HW, Yoo J. Limitations of current screening methods for lipid disorders in Korean adolescents and a proposal for an effective detection method: a nationwide, cross-sectional study. Ann Pediatr Endocrinol Metab. 2020;25(4):265-71. doi:10.6065/apem.2040098.049.
28. Leyva-Vela B, Martínez-Olcina M, Asencio-Mas N, Vicente-Martínez M, Cuestas-Calero BJ, Mat?osz P, et al. Integrated multivariate predictive model of body composition and lipid profile for cardiovascular risk assessment. J Clin Med. 2025;14(3):781. doi:10.3390/jcm14030781.
29. Assani MZ, Novac MB, Dijm?rescu AL, V?duva CC, Vladu IM, Clenciu D, et al. Potential association between atherogenic coefficient, prognostic nutritional index, and various obesity indices in diabetic nephropathy. Nutrients. 2025;17(8):1339. doi:10.3390/nu17081339.
30. Korhonen PE, Kiiski S, Kautiainen H, Ojanen S, Tertti R. The relationship of kidney function, cardiovascular morbidity, and all-cause mortality: a prospective primary care cohort study. J Gen Intern Med. 2023;38(8):1834-42. doi:10.1007/s11606-022-07885-8.
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