Visceral fat-to-muscle mass ratio to predict cardiovascular events and mortality in patients with chronic obstructive pulmonary disease A prospective cohort study

Background: Chronic obstructive pulmonary disease (COPD) patients can have increased cardiovascular events risk, which might be impacted by an imbalance between fat and muscle mass. This study explores the relationships between visceral fat-to-muscle mass ratio (VMR) and cardiovascular events and mortality in COPD patients. Methods: A prospective cohort study was performed on COPD patients from May 2018 to December 2023. Baseline information and VMR were collected. The primary outcome was major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, stroke, and exacerbation of congestive heart failure. Secondary outcomes were non-fatal cardiovascular events and mortality. Cox regression models, Kaplan–Meier curves, and restricted cubic splines were applied to assess the relationship between VMR and outcomes. Results: Of 1045 COPD patients, 138 (13.2 %) experienced MACE, and 169 (16.2 %) experienced non-fatal cardiovascular events and mortality during an average of 62-month follow-up period. VMR was nonlinearly associated with MACE (P = 0.023), with one-standard-deviation VMR increase leading to a 50 % increase in MACE risk (hazard ratio, HR, = 1.50, 95 % confidence interval, CI = 1.17–1.93) and 20 % increase in non-fatal cardiovascular event and mortality risk (HR = 1.20, 95 % CI = 1.08–1.34). The cumulative MACE incidence rose with higher VMR categories (log-rank P < 0.0001). In the fully adjusted model, the highest VMR quartile was significantly associated with a greater MACE risk than the lowest VMR (HR = 5.18, 95 % CI = 2.75–9.75). Sensitivity analyses confirmed the robustness of these findings. Subgroup analyses indicated a more significant VMR impact in those below 60. Conclusions: Elevated VMR was associated with increased MACE among COPD patients.