Objective To investigate the relationships between body morphology parameters—including body mass index (BMI), waist circumference, body fat percentage, and the Chinese visceral adiposity index (CVAI)—and the 10-year cardiovascular disease (CVD) risk, cardiac age score, and rate of ideal blood pressure levels in patients with type 2 diabetes mellitus (T2DM).

Methods A cross-sectional analysis was conducted involving 10,067 T2DM patients from The First Affiliated Hospital of Fujian Medical University. Patients were categorized into low-to-medium risk (risk ≤20%) and high-risk (risk ＞20%) groups based on the Framingham 10-year CVD risk score. Spearman correlation analysis was used to assess the linear associations of BMI, waist circumference, body fat percentage, and CVAI with the 10-year CVD risk, cardiac age score, and blood pressure. Restricted cubic spline (RCS) analysis with 4 knots was further employed to identify nonlinear inflection points for each parameter.

Results Compared to the low-to-medium risk group, the high-risk group was older, had a higher proportion of males, and exhibited significantly higher levels of BMI, waist circumference, CVAI, blood pressure, triglycerides, and low-density lipoprotein cholesterol (all P＜0.001). Specific examples included: BMI (24.67, IQR: 22.57 to 27.01 vs. 23.88 IQR: 21.50 to 26.31, Z = −10.71), waist circumference (89.42 ± 9.73 cm vs. 85.17 ± 10.66 cm, t = −18.31), and CVAI (126.28 ± 39.66 vs. 99.07 ± 39.94, t = − 29.02). Spearman correlation analysis revealed that all body morphology parameters were positively correlated with both the 10-year CVD risk and the cardiac age score (all P＜0.001): BMI (r = 0.213; r = 0.160), waist circumference (r = 0.235; r = 0.152), body fat percentage (r = 0.113; r = 0.424), and CVAI (r = 0.351; r = 0.344). RCS analysis identified inflection points at BMI 24.35 kg/m², waist circumference 87 cm, body fat percentage 29.2%, and CVAI 115.06. For values below these inflection points, the 10-year CVD risk and cardiac age score increased with rising parameter values, while the rate of ideal blood pressure levels decreased. Defining target achievement as having parameter values below these inflection points, logistic regression analysis demonstrated a dose-response relationship between the number of body morphology parameters meeting the targets and the outcomes. Each additional parameter meeting the target was associated with a 13.5% reduction in 10-year CVD risk (OR=0.865, 95% CI: 0.829 to 0.902, P＜0.001), an 11.7% reduction in high cardiac age risk (OR=0.883, 95%CI: 0.835 to 0.933, P＜0.001), and a 13.6% increase in the rate of ideal blood pressure levels (OR=1.136, 95%CI: 1.101 to 1.172, P＜0.001).

Conclusion Comprehensive management of multiple body morphology parameters may significantly reduce cardiovascular risk in diabetic patients, providing evidence-based support for precise weight management strategies.