Xiaohua He Jingling Zhu Wenfei Liang Xiuling Yang Weimin Ning Zhan Zhao Jingyi Chen Jingyi Chen ^* Qiuxing He ^*

• Dongguan Hospital of Traditional Chinese Medicine, Dongguan, Guangdong Province, China

Background: Cardiometabolic syndrome (CMS), marked by abdominal obesity and metabolic dysregulation, is associated with a heightened risk of cardiovascular disease (CVD). Compared to the traditional anthropometric predictors represented by body mass index (BMI) and waist circumference (WC), body roundness index (BRI) appears to provide a more accurate reflection of the abdominal fat distribution associated with metabolic diseases. Therefore, this study intends to investigate the association of BRI with the risk of CVD and its components including congestive heart failure (CHF), coronary heart disease (CHD), angina, heart attack, and stroke in patients with CMS. At the same time, we hypothesized that BRI would identify CVD better than BMI or WC. Methods: Data from the 2009-2018 National Health and Nutrition Examination Survey (NHANES). Logistic regression models were mainly utilized to evaluate the relationship between BRI and CVD in patients with CMS, including smooth curve analysis, threshold effects analysis, subgroup analysis and multiple imputation. In addition, receiver operating characteristic (ROC) curves were used to assess the ability of BRI to predict CVD. Results: The logistic regression model showed a positive association between the BRI and CVD. The highest quartile of BRI (Q4) showing the strongest association with CVD. The smoothed curve revealed a linear relationship between BRI and CVD, but a U-shaped association between the BRI and CHF. For CVD, stratified analyses did not show significant difference between strata. For CHF, BMI interacted with the association, with BRI being associated with decreased risk of CHF in a subgroup of normalweight subjects and increased risk of CHF in a subgroup of obese subjects. The multiple imputation further confirmed the robustness of these results. Additionally, the ROC curve indicated that BRI, BMI and WC had predictive power for CVD and CHF (AUC > 0.05). BRI has similar predictive power to WC but better than BMI. Conclusions: An elevated BRI is associated with a heightened risk of CVD in patients with CMS. BRI has similar ability to predict CVD and CHF as WC, but superior to BMI.