ObjectiveThe purpose of this study was to examine the association between the VAI (visceral adiposity index) and stroke prevalence and age at stroke in US adults.MethodsWe examined the association between VAI and stroke prevalence and age at stroke using logistic regression, subgroup analysis, and dose-response curves using participants from the National Health and Nutrition Examination Survey (NHANES) database from 2007-2018.ResultsThis study ultimately included 29,337 participants aged >20 years, of whom 1022 self-reported a history of stroke, and after adjusting for all confounders, each unit increase in corrected VAI was associated with a 12% increase in the prevalence of stroke (OR= 1.12, 95% CI: 1.01, 1.24) along with an earlier age at stroke 1.64 years (β= -1.64, 95% CI: -2.84, -0.45), stratified analysis showed that the prevalence of stroke was 20% higher in the female group (OR= 1.20, 95% CI: 1.04, 1.39), black group (OR= 1.22, 95% CI: 1.01, 1.48), age ≤60 years group (OR= 1.25, 95% CI: 1.05, 1.48), hypertensive group (OR=1.15, 95% CI:1.01, 1.31), and diabetic group (OR=1.23, 95% CI:1.02, 1.48) VAI increase was positively correlated with stroke prevalence increase. The dose-response curves showed a positive linear correlation between increased VAI and stroke prevalence, while a negative linear correlation was observed between increased VAI and age at stroke.ConclusionAlthough a causal relationship cannot be proven, higher VAI was positively associated with stroke prevalence and can lead to earlier stroke onset.