Abstract
BACKGROUND: The body roundness index (BRI) offers a more precise evaluation of body fat and visceral fat levels. However, studies on the relationship between BRI and the risk of cardiovascular disease (CVD) remain limited. METHODS: Survival differences across BRI quartiles were estimated using Kaplan-Meier analysis. The association between the BRI and the risk of CVD was examined through Cox proportional hazards and restricted cubic spline (RCS) models. Additional subgroup and sensitivity analyses were also conducted. RESULTS: This study included 6401 patients (47.43% male), with an incidence of CVD of 17.51%. Kaplan-Meier survival analysis revealed statistically significant differences between groups based on the assigned BRI quartiles. Cox models revealed a strong association between the BRI and CVD risk, while RCS models showed a non-linear link between higher BRIs and increased CVD risk. In certain subgroups, an elevated BRI was closely correlated with an increased incidence of CVD. Notable interactions were found between BRI and gender, age, hypertension, diabetes, alcohol consumption, and smoking status. Sensitivity analysis excluding early CVD cases yielded consistent results. CONCLUSION: A significant non-linear association was found between the BRI and CVD risk. The BRI could be a valuable and sensitive marker for identifying individuals at high risk of CVD, with varying predictive value across different population subgroups.