Abstract Body (Do not enter title and authors here): Background:
Menopause is associated with adverse changes in vascular function that significantly increase vessel stiffness and cardiovascular disease (CVD) risk. Given the rising CVD risk in both younger and older adult females, it is important to identify predictors of vascular health, including body composition and physical activity levels, in both pre- and postmenopausal women.

Research Questions:
What are the optimal body composition and physical activity predictors of vascular health in Asian women, and do these predictors differ by menopausal status?

Methods:
A total of 236 Asian women (125 premenopausal, 111 postmenopausal) were evaluated for vascular health using carotid-femoral pulse wave velocity, central augmentation index, and mean arterial pressure assessed by SphygmoCor XCEL. Body composition measures included body fat percentage, skeletal muscle mass, and visceral adipose tissue, while anthropometric measures included body mass index and waist circumference. Physical activity was self-reported using the International Physical Activity Questionnaire. Multiple linear regression analyses were used to identify optimal predictors within and across menopausal groups.

Results:
For both pre- and postmenopausal samples, multiple linear regression showed that visceral adipose tissue positively predicted carotid-femoral pulse wave velocity (p<0.001). Skeletal muscle mass positively predicted central augmentation index (p=0.029), while body fat percentage (p=0.020) was inversely related to central augmentation index (p=0.020). There were no predictors of mean arterial pressure. In premenopausal women, visceral adipose tissue positively predicted carotid-femoral pulse wave velocity (p=0.013). Furthermore, waist circumference positively predicted central augmentation index (p=0.010), while skeletal muscle mass was inversely related to central augmentation index (p=0.033). In postmenopausal women, visceral adipose tissue was a significant predictor of both carotid-femoral pulse wave velocity (p=0.001) and mean arterial pressure (p=0.022). Physical activity was not predictive in any model.

Conclusions:
Visceral adipose tissue is considered the strongest predictor of vascular health in both pre- and postmenopausal Asian women. In premenopausal women only, higher waist circumference and lower skeletal muscle mass contributed to vessel stiffness and poor vascular health, highlighting the importance of early identification and preventive strategies before menopause.