Abstract: Objective To explore the relationship between Chinese visceral adiposity index （CVAI） and new-onset stroke in a large sample cohort of middle-aged and elderly individuals. Methods A Cox regression model was established using data from the China Health and Retirement Longitudinal Study （CHARLS） conducted between 2011 and 2018,to investigate the relationship between CVAI and new-onset stroke. Restricted cubic spline model was used to examine potential non-linear relationships,while subgroup analyses explored the moderating effects of social,demographic,and economic factors. Results A total of 6 902 participants were included in this study,among whom 398 （5.76%） experienced new-onset stroke. The median CVAI at baseline was 93.26 （63.21,123.96）,and the CVAI in new-onset stroke patients was higher than that in non- new-onset stroke patients （P<0.01）. Cox regression model results showed that after adjusting covariates,the risk of new-onset stroke increased by 67.2% for every one quartile increase of CVAI （60.75） （P<0.01）. Compared with CVAI Q₁ group （< 63.21）,CVAI Q₂,Q₃,and Q₄ groups （63.21 - <93.26,93.26- <123.96,and ≥123.96） had an increased risk of new-onset stroke by 78.5%,96.7%,and 184.2%,respectively （all P < 0.01）. The risk of new-onset stroke increased with increasing CVAI （P_trend < 0.001）. Restricted cubic spline regression analysis showed that there was a dose-response relationship between CVAI and new-onset stroke （P<0.01）,and the relationship was linear （P_nonliner =0.53）. Subgroup analysis showed that age may have a moderating effect on the relationship between the two groups （P_interaction <0.05）,and the lower age group was more affected. Conclusions The CVAI is closely associated with new-onset stroke,showing a dose-response relationship. Younger individuals with high CVAI should be particularly vigilant about their risk for developing strokes.

Key words: Middle-aged and elderly, Chinese visceral adiposity index, New-onset stroke, Dose-response relationship