This study investigates the dose-response relationship between the Chinese visceral adiposity index (CVAI) and the risk of cardiovascular disease (CVD), heart disease, and stroke in a national prospective cohort of Chinese adults. The study analyzed data from 7,439 participants aged ≥45 years, recruited from the China Health and Retirement Longitudinal Study (CHARLS). Over a 7-year follow-up period, 1,326 incident CVD cases, 1,032 incident heart disease cases, and 399 stroke cases were identified. The results showed a linear association between CVAI and the risk of CVD, heart disease, and stroke, with higher CVAI quartiles associated with increased risk. A per-standard deviation increase in CVAI was linked to a 17% increased risk of CVD, 12% for heart disease, and 31% for stroke. The risk of CVD, heart disease, and stroke was higher in participants under 60 years of age compared to those aged ≥60 years. The study also compared the predictive ability of CVAI with other obesity indices, including visceral adiposity index (VAI), body shape index (ABSI), conicity index (CI), waist circumference (WC), and body mass index (BMI). The results showed that CVAI had the highest predictive value for CVD, heart disease, and stroke. The study concludes that CVAI is a reliable and applicable obesity index for identifying higher CVD risk in Chinese adults. The findings support the use of CVAI as a suitable visceral obesity index for predicting CVD in Chinese or other Asian adults. The study highlights the importance of CVAI in assessing cardiovascular risk and suggests that it could be used in routine clinical practice and large cohort studies. The study also discusses the potential mechanisms linking visceral obesity to CVD, including systemic and vascular inflammation, oxidative stress, and insulin resistance. The study has limitations, including the inability to evaluate the dynamic changes in CVAI and the lack of adjustment for residual confounders such as diet and air pollution. The study provides valuable insights into the relationship between CVAI and CVD and supports the use of CVAI as a reliable tool for assessing cardiovascular risk in Chinese adults.This study investigates the dose-response relationship between the Chinese visceral adiposity index (CVAI) and the risk of cardiovascular disease (CVD), heart disease, and stroke in a national prospective cohort of Chinese adults. The study analyzed data from 7,439 participants aged ≥45 years, recruited from the China Health and Retirement Longitudinal Study (CHARLS). Over a 7-year follow-up period, 1,326 incident CVD cases, 1,032 incident heart disease cases, and 399 stroke cases were identified. The results showed a linear association between CVAI and the risk of CVD, heart disease, and stroke, with higher CVAI quartiles associated with increased risk. A per-standard deviation increase in CVAI was linked to a 17% increased risk of CVD, 12% for heart disease, and 31% for stroke. The risk of CVD, heart disease, and stroke was higher in participants under 60 years of age compared to those aged ≥60 years. The study also compared the predictive ability of CVAI with other obesity indices, including visceral adiposity index (VAI), body shape index (ABSI), conicity index (CI), waist circumference (WC), and body mass index (BMI). The results showed that CVAI had the highest predictive value for CVD, heart disease, and stroke. The study concludes that CVAI is a reliable and applicable obesity index for identifying higher CVD risk in Chinese adults. The findings support the use of CVAI as a suitable visceral obesity index for predicting CVD in Chinese or other Asian adults. The study highlights the importance of CVAI in assessing cardiovascular risk and suggests that it could be used in routine clinical practice and large cohort studies. The study also discusses the potential mechanisms linking visceral obesity to CVD, including systemic and vascular inflammation, oxidative stress, and insulin resistance. The study has limitations, including the inability to evaluate the dynamic changes in CVAI and the lack of adjustment for residual confounders such as diet and air pollution. The study provides valuable insights into the relationship between CVAI and CVD and supports the use of CVAI as a reliable tool for assessing cardiovascular risk in Chinese adults.