Abstract Body (Do not enter title and authors here): Background: Visceral adipose tissue (VAT) is a metabolically active fat depot strongly associated with cardiometabolic disease. This study evaluates whether MRI-derived VAT enhances the discrimination and calibration of the PREVENT model for atherosclerotic cardiovascular disease (ASCVD) heart failure (HF), and total cardiovascular disease (CVD) in a large, population-based cohort.
Methods: We included 38,373 UK Biobank participants who underwent abdominal MRI and had no known CVD at baseline. We assessed whether adding VAT to PREVENT would improve model performance using C-statistics and net reclassification improvement (NRI).
Results: The mean age was 54.86 years (SD 7.49), and 52% of participants were female. The median VAT volume was 3.58L (IQR:2.14-5.33). Using the overall median VAT value as the threshold, higher visceral adiposity (>3.58L) was associated with significantly increased risk of ASCVD (HR: 1.32, 95% CI: 1.15–1.51), heart failure (HR: 1.55, 95% CI: 1.27–1.89), and total CVD (HR: 1.38, 95% CI: 1.23–1.55) adjusting for age and sex (Figure 1). Adding VAT to the PREVENT model did not significantly improve discrimination for ASCVD (C-statistic 0.731 vs. 0.729, p = 0.85), nor for HF or total CVD. However, VAT significantly improved reclassification: NRI for ASCVD was 0.37 (95% CI: 0.30–0.33), for HF was 0.48 (95% CI: 0.35–0.61), and for total CVD was 0.37 (95% CI: 0.28–0.46) (Table 1). The association between VAT and all outcomes remained robust after adjustment for age and sex.
Conclusions: MRI-measured visceral adiposity is associated with increased risk of ASCVD, HF, and total CVD. While VAT did not improve overall discrimination of the PREVENT model, it significantly enhanced reclassification—particularly for HF. This suggests that VAT may improve individualized cardiovascular risk stratification and inform targeted preventive strategies.