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Cardiovascular disease (CVD) risk stratification often relies on anthropometric measures that do not fully reflect central adiposity or differences across populations. The Body Roundness Index (BRI) is a body-shape indicator that may improve assessment of cardiometabolic risk, but evidence from large national cohorts remains limited. This study analyzed harmonized data from the China Health and Retirement Longitudinal Study (CHARLS, 2015) and the U.S. National Health and Nutrition Examination Survey (NHANES, 2005–2016) to examine the relationship between BRI and prevalent CVD. Participants were grouped into quartiles of BRI, with the highest quartile serving as the reference. Weighted multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with sequential adjustment for demographic and clinical covariates. Subgroup analyses were performed to evaluate heterogeneity across population strata, and an extreme gradient boosting (XGBoost) model was applied to assess the relative importance of BRI and other predictors. In both cohorts, individuals with CVD were older and had higher prevalences of hypertension and diabetes, whereas BRI distributions differed between cohorts. Lower BRI quartiles were associated with greater odds of CVD. Compared with Q4, Q1 was associated with increased CVD risk in CHARLS (OR 1.73, 95% CI 1.14-2.68; p=0.012) and NHANES (OR 1.82, 95% CI 1.44-2.30; p<0.001). These findings suggest that lower BRI is associated with higher CVD risk and may complement conventional anthropometric measures in population-based cardiovascular risk assessment.

ISSN: 2836-3795